Provider Demographics
NPI:1386321537
Name:KAUFMAN, JORDAN NICOLE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MASSACHUSETTS AVE STE 4-1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3067
Mailing Address - Country:US
Mailing Address - Phone:617-996-8821
Mailing Address - Fax:617-812-1697
Practice Address - Street 1:875 MASSACHUSETTS AVE STE 4-1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3067
Practice Address - Country:US
Practice Address - Phone:617-996-8821
Practice Address - Fax:617-812-1697
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10000853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health