Provider Demographics
NPI:1659187888
Name:JORDAN, STEVEN MARK (EDS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MARK
Last Name:JORDAN
Suffix:
Gender:
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N VAIL ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1939
Mailing Address - Country:US
Mailing Address - Phone:703-732-3123
Mailing Address - Fax:
Practice Address - Street 1:7000 OLD GATE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4456
Practice Address - Country:US
Practice Address - Phone:240-740-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1001581551103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool