Healthcare Provider Details

I. General information

NPI: 1669397105
Provider Name (Legal Business Name): DR. JORDAN D ALEXANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 STATE HOSPITAL DR
BANGOR ME
04401-8816
US

IV. Provider business mailing address

184 FOREST AVE APT 1
BANGOR ME
04401-4186
US

V. Phone/Fax

Practice location:
  • Phone: 877-421-8263
  • Fax:
Mailing address:
  • Phone: 818-297-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: