Provider Demographics
NPI:1720064496
Name:JORDAN, TERRIE L (LICSW)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 VANDENBERG DR
Mailing Address - Street 2:66 MDS(AFMC) BLDG 1900
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731-2104
Mailing Address - Country:US
Mailing Address - Phone:781-225-6789
Mailing Address - Fax:781-225-2576
Practice Address - Street 1:90 VANDENBERG DR
Practice Address - Street 2:66 MDS(AFMC) BLDG 1900
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731-2104
Practice Address - Country:US
Practice Address - Phone:781-225-6789
Practice Address - Fax:781-225-2576
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical