Active NPI
Nicole Jordan, L.M.H.C
- Mental Health Counselor
- Canton, MA
National Provider Identifier
1093157661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 8162
- Practice address
- 8 Shore Dr
Canton, MA 02021-2652 - Phone
- (339) 206-3403
- NPI assigned
- Jul 24, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 8162 | MA | Primary |
Addresses
Primary practice location
8 Shore Dr
Canton, MA 02021-2652
Mailing address
8 Shore Dr
Canton, MA 02021-2652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8162 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586217600000",
"number": "1093157661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 SHORE DR",
"city": "CANTON",
"state": "MA",
"postal_code": "020212652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 SHORE DR",
"city": "CANTON",
"state": "MA",
"postal_code": "020212652",
"telephone_number": "339-206-3403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "NICOLE",
"credential": "L.M.H.C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-24",
"last_updated": "2020-04-07",
"certification_date": "2020-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "8162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.