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General NPI Number Information
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NPI Number | 1245354232
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Entity Type | Individual
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Provider Name | PAULINE HOPPER JORDAN PHD
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Gender | Female
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 132 E PUTNAM AVE
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City | COS COB
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State | CT
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Zip | 06807-2744
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Country | US
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Telephone | 203-622-9868
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Fax |
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Provider Business Mailing Address
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Address Line | 132 E PUTNAM AVE
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City | COS COB
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State | CT
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Zip | 06807-2744
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Country | US
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Telephone | 203-622-9868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 001907
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 001907
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 001907
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 001907
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 001907
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License Number State | CT
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