Provider Demographics
NPI:1417444936
Name:JORDAN, JILL M (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1634
Mailing Address - Country:US
Mailing Address - Phone:774-360-3814
Mailing Address - Fax:
Practice Address - Street 1:276 SALEM ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1634
Practice Address - Country:US
Practice Address - Phone:774-360-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2436103K00000X
MA2435103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst