Provider Demographics
NPI:1487746517
Name:JORDAN, SARAH (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JORDAN
Other - Last Name:HOLLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:370 PORTSMOUTH AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-2252
Mailing Address - Country:US
Mailing Address - Phone:603-502-1309
Mailing Address - Fax:
Practice Address - Street 1:370 PORTSMOUTH AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2252
Practice Address - Country:US
Practice Address - Phone:603-502-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC9381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME418270099Medicaid
MEME0491Medicare ID - Type UnspecifiedMEDICARE NUMBER