Provider Demographics
NPI:1912212457
Name:JORDAN, MARY E (LMFT, LADC, CEAP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMFT, LADC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CLARA DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1973
Mailing Address - Country:US
Mailing Address - Phone:866-804-2273
Mailing Address - Fax:860-536-4660
Practice Address - Street 1:14 CLARA DR STE 3
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1973
Practice Address - Country:US
Practice Address - Phone:866-804-2273
Practice Address - Fax:860-536-4660
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000163101YA0400X
CT000800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)