Provider Demographics
NPI:1548606940
Name:JORDAN, CARY (PHD)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 MARKET ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-729-8700
Mailing Address - Fax:330-729-8701
Practice Address - Street 1:8423 MARKET ST
Practice Address - Street 2:STE 101
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-729-8700
Practice Address - Fax:330-729-8701
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8706103TB0200X
OH7319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH354920Medicare UPIN