Active NPI
Melissa Dawn Phillips Jordan, PH.D.
- Clinical Psychologist
- Washington, DC
National Provider Identifier
1659631935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 05118
- Practice address
- 1701 Pennsylvania Ave NW
Washington, DC 20006-5805 - Phone
- (301) 875-5216
- NPI assigned
- May 21, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 05118 | MD | Primary |
| Clinical Psychologist | 103TC0700X | 1000795 | DC | |
| Clinical Psychologist | 103TC0700X | 019034 | NY |
Addresses
Primary practice location
1701 Pennsylvania Ave NW
Washington, DC 20006-5805
Mailing address
131 Weymouth St
Upper Marlboro, MD 20774-1744
Phone (301) 875-5216
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 |
|---|---|---|---|
| 1000795 | DC | MD | Clinical Psychologist |
| 019034 | NY | MD | Clinical Psychologist |
| 05118 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433116800000",
"number": "1659631935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 WEYMOUTH ST",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741744",
"telephone_number": "301-875-5216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 PENNSYLVANIA AVE NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200065805",
"telephone_number": "301-875-5216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS JORDAN",
"first_name": "MELISSA",
"middle_name": "DAWN",
"name_prefix": "Mrs.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-21",
"last_updated": "2015-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05118",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "DC",
"license": "1000795",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019034",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.