Provider Demographics
NPI:1609323716
Name:LUPO, JORDAN MARIE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:LUPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 WASHINGTON ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3506
Mailing Address - Country:US
Mailing Address - Phone:203-921-7894
Mailing Address - Fax:
Practice Address - Street 1:6 KIMBALL LN
Practice Address - Street 2:SUITE 310
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2682
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker