Jordan Allen Calloway, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY10485 Issued in FL

Practice address

853 State Road 436 Ste 2045
Casselberry, FL 32707-5480

Phone

(407) 598-0202

NPI assigned

Nov 21, 2011

Last updated

Apr 13, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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

{
    "created_epoch": "1321833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1619244571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 TUSCANY BEND ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175545",
            "telephone_number": "386-479-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 STATE ROAD 436 STE 2045",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "327075480",
            "telephone_number": "407-598-0202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 Park Place Blvd",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347412344",
            "country_code": "US",
            "telephone_number": "407-846-0023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1848 SE 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "33316",
            "country_code": "US",
            "telephone_number": "954-885-9500",
            "fax_number": "954-885-9444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "531 W Union St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322024047",
            "country_code": "US",
            "telephone_number": "904-595-6516",
            "fax_number": "904-406-2063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLOWAY",
        "first_name": "JORDAN",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-21",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Casselberry, FL
• Providers in Casselberry, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; 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.