Provider Demographics
NPI:1952389116
Name:JORDAN, JUDITH VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:VICTORIA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BARBERRY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8025
Mailing Address - Country:US
Mailing Address - Phone:617-855-2140
Mailing Address - Fax:781-860-9592
Practice Address - Street 1:114 WALTHAM ST
Practice Address - Street 2:SUITE 17
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5415
Practice Address - Country:US
Practice Address - Phone:617-855-2149
Practice Address - Fax:781-860-9592
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist