Provider Demographics
NPI:1457443590
Name:VIEIRA, JORDAN RALPH JR (AAS,CASAC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:RALPH
Last Name:VIEIRA
Suffix:JR
Gender:M
Credentials:AAS,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-9735
Mailing Address - Country:US
Mailing Address - Phone:585-750-4103
Mailing Address - Fax:
Practice Address - Street 1:6017 HICKS RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512-9735
Practice Address - Country:US
Practice Address - Phone:585-750-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)