David Jordan

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

107004-01 Issued in NY

Practice address

1612 Genesee St
Utica, NY 13502-5425

Phone

(315) 724-5173

NPI assigned

Sep 28, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samaritan Counseling Center of the Mohawk Valley, Inc

  • Mental Health Counselor
  • Utica, NY
  • NPI 1649377854
  NPD
• Samaritan Counseling Center of the Mohawk Valley, Inc

  • Social Worker
  • Utica, NY
  • NPI 1588903454
  NPD (past)

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1528675006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 GENESEE ST",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135025425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 GENESEE ST",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135025425",
            "telephone_number": "315-724-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "107004-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "djordan@samaritancentermv.com",
            "affiliation": "N",
            "address_1": "1612 Genesee St",
            "city": "Utica",
            "state": "NY",
            "country_code": "US",
            "postal_code": "135025425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacquette Jones
• Jessie Jones
• Maria Jones
• Michelle M Jones
• Timothy Joseph Jones, NPP
• Michelle Jordan, PHYSICAL THERAPY ASS
• Kathy A Jorgensen
• William Jorgensen, DO
• Joanne Joseph, PHD
• Patricia Schell Joseph

• Mental Health Counselor in Utica, NY
• Providers in Utica, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.

Verify at the official NPI Registry.