Provider Demographics
NPI:1831394931
Name:JORDAN, MARY ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2907
Mailing Address - Country:US
Mailing Address - Phone:914-358-5631
Mailing Address - Fax:914-358-5630
Practice Address - Street 1:244 WESTCHESTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2907
Practice Address - Country:US
Practice Address - Phone:914-358-5631
Practice Address - Fax:914-358-5630
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0093642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV50492Medicare ID - Type Unspecified