Provider Demographics
NPI:1376246926
Name:BOSTON, JORDAN HAILEY (LMHC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:HAILEY
Last Name:BOSTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2203
Mailing Address - Country:US
Mailing Address - Phone:845-325-9189
Mailing Address - Fax:
Practice Address - Street 1:620 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1170
Practice Address - Country:US
Practice Address - Phone:845-353-2730
Practice Address - Fax:845-353-2358
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health