Provider Demographics
NPI:1194412106
Name:HOPPES, JORDAN (PSYD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HOPPES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 BUFFALO RD UNIT 232
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1507
Mailing Address - Country:US
Mailing Address - Phone:585-285-9164
Mailing Address - Fax:
Practice Address - Street 1:2117 BUFFALO RD UNIT 232
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1507
Practice Address - Country:US
Practice Address - Phone:585-285-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY10001103103TC0700X
390200000X
NY026812103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program