Provider Demographics
NPI:1972346534
Name:MADDOX, JORDYN L
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:L
Last Name:MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-2232
Mailing Address - Country:US
Mailing Address - Phone:860-478-8410
Mailing Address - Fax:
Practice Address - Street 1:72 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-2232
Practice Address - Country:US
Practice Address - Phone:860-478-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician