Organization
JUDITH V JORDAN,PH.D.,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDITH VICTORIA JORDAN PH.D. (PSYCHOLOGIST)
(617) 855-2140
Entity
Organization
Contact information
Practice address
114 WALTHAM ST, SUITE 17, LEXINGTON, MA 02421-5415
(617) 855-2140
(781) 860-9592
Mailing address
114 WALTHAM ST, SUITE 17, LEXINGTON, MA 02421-5415
(617) 855-2140
(781) 860-9592
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1019
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W10450
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/29/2008
Last updated
08/29/2008
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