Provider Demographics
NPI:1639618010
Name:JORDAN, STEPHENQ MICHEAL (MS)
Entity Type:Individual
Prefix:
First Name:STEPHENQ
Middle Name:MICHEAL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PINE HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2850
Mailing Address - Country:US
Mailing Address - Phone:855-830-4329
Mailing Address - Fax:
Practice Address - Street 1:31 WORKSHOP RD
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1210
Practice Address - Country:US
Practice Address - Phone:855-830-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)