Active NPI
Catharina Ann Jordan
- Clinical Psychologist
- Melbourne, FL
National Provider Identifier
1588896153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P.08273
- Practice address
- 1299 Bedford Dr
Suite a
Melbourne, FL 32940-1900 - Phone
- (321) 259-1662
- NPI assigned
- Aug 17, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY9617 | FL | |
| Clinical Psychologist | 103TC0700X | P.08273 | OH | Primary |
Addresses
Primary practice location
1299 Bedford Dr
Suite a
Melbourne, FL 32940-1900
Mailing address
9200 Montgomery Rd Ste 23B
Montgomery, OH 45242-7794
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 30, 2022 through Mar 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY9617 | FL | MD | Clinical Psychologist |
| P.08273 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1588896153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9200 MONTGOMERY RD STE 23B",
"city": "MONTGOMERY",
"state": "OH",
"postal_code": "452427794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1299 BEDFORD DR",
"address_2": "SUITE A",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329401900",
"telephone_number": "321-259-1662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "CATHARINA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-17",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY9617",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "P.08273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.