Individual
JORDAN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
41 PACELLA PARK DR, RANDOLPH, MA 02368-1755
(781) 440-0400
Mailing address
41 PACELLA PARK DR, RANDOLPH, MA 02368-1755
(781) 440-0400
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
01/03/2017
Last updated
08/30/2017
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