Provider Demographics
NPI:1255083986
Name:JORDAN, RABIYAH
Entity type:Individual
Prefix:MS
First Name:RABIYAH
Middle Name:
Last Name:JORDAN
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 1:9854 LIBERTY RD STE D
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2058
Mailing Address - Country:US
Mailing Address - Phone:410-429-0897
Mailing Address - Fax:
Practice Address - Street 1:9854 LIBERTY RD STE D
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2058
Practice Address - Country:US
Practice Address - Phone:410-429-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician