NPIMap

Organization Active NPI

Judith V Jordan,PH.D.,PC

  • Psychologist
  • Lexington, MA
National Provider Identifier
1063660207
Registry record updated Aug 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1019 Issued in MA
Legal business name
JUDITH V JORDAN,PH.D.,PC
Practice address
114 Waltham St
Suite 17
Lexington, MA 02421-5415
Phone
(617) 855-2140
Fax
(781) 860-9592
NPI assigned
Aug 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Judith Victoria Jordan, PH.D.NPI 1952389116
Title
Psychologist
Phone
(617) 855-2140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 1019 MA Primary

Addresses

Primary practice location

114 Waltham St
Suite 17
Lexington, MA 02421-5415

Mailing address

114 Waltham St
Suite 17
Lexington, MA 02421-5415
Phone (617) 855-2140

Other identifiers 1

IdentifierTypeStateIssuer
W10450OtherMABLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

114 Waltham St
Ste 17
Lexington, MA 02421
Phone (617) 855-2140

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1063660207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 WALTHAM ST",
            "address_2": "SUITE 17",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024215415",
            "telephone_number": "617-855-2140",
            "fax_number": "781-860-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WALTHAM ST",
            "address_2": "SUITE 17",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024215415",
            "telephone_number": "617-855-2140",
            "fax_number": "781-860-9592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDITH V JORDAN,PH.D.,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "VICTORIA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "617-855-2140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MA",
            "license": "1019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W10450",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.