Provider Demographics
NPI:1912404542
Name:COX, JORDAN DELPHINE (RBT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:DELPHINE
Last Name:COX
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:JORDAN
Other - Middle Name:DELPHINE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JORDAN COX
Mailing Address - Street 1:500 FAIRWAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1817
Mailing Address - Country:US
Mailing Address - Phone:888-880-9270
Mailing Address - Fax:
Practice Address - Street 1:500 FAIRWAY DR STE 102
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1817
Practice Address - Country:US
Practice Address - Phone:561-222-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician