Active NPI
John Robert Jordan, PH.D.
- Clinical Psychologist
- Pawtucket, RI
National Provider Identifier
1235296377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1936
- Practice address
- 10 Exchange CT
Unit 401
Pawtucket, RI 02860-2261 - Phone
- (401) 305-3051
- Fax
- (401) 305-3051
- NPI assigned
- Jan 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1936 | MA | Primary |
Addresses
Primary practice location
10 Exchange CT
Unit 401
Pawtucket, RI 02860-2261
Mailing address
10 Exchange CT
Unit 401
Pawtucket, RI 02860-2261
Phone (401) 305-3051
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1936 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204848000000",
"number": "1235296377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 EXCHANGE CT",
"address_2": "UNIT 401",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028602261",
"telephone_number": "401-305-3051",
"fax_number": "401-305-3051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 EXCHANGE CT",
"address_2": "UNIT 401",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028602261",
"telephone_number": "401-305-3051",
"fax_number": "401-305-3051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "JOHN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-01",
"last_updated": "2008-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "1936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.