Individual provider Active NPI

Edith Jordan

  • Counselor
  • Elmira, NY
National Provider Identifier
1619545514
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
1019 E Water St
Elmira, NY 14901-3332
Phone
(607) 733-5696
Fax
(607) 737-1379
NPI assigned
Jun 16, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NY Primary

Addresses

Primary practice location

1019 E Water St
Elmira, NY 14901-3332

Mailing address

1019 E Water St
Elmira, NY 14901-3332
Phone (607) 733-5696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250610004054 NY Practitioner - Mental Health Counselor 9436669231 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
015995NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Services of Chemung County, Inc. Counselor CurrentSince Apr 17, 2025 Accepting new patients

Locations

1019 E Water St
Elmira, NY 14901
Phone (607) 733-5696

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1619545514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 E WATER ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013332",
            "telephone_number": "607-733-5696",
            "fax_number": "607-737-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 E WATER ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013332",
            "telephone_number": "607-733-5696",
            "fax_number": "607-737-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "EDITH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-16",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmira, NY

Sources for this page

Verify at the official NPI Registry.