Provider Demographics
NPI:1134944143
Name:HUBER, JORDAN (MA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HUBER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3109
Mailing Address - Country:US
Mailing Address - Phone:215-645-0338
Mailing Address - Fax:215-709-3453
Practice Address - Street 1:325 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3109
Practice Address - Country:US
Practice Address - Phone:215-645-0338
Practice Address - Fax:215-709-3453
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health