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General NPI Number Information
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NPI Number | 1730988254
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Entity Type | Organization
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Legal Business Name | JOURDAN MARIE PORTER, PSYD MED LLC
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 100 S BROAD ST STE 834
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City | PHILADELPHIA
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State | PA
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Zip | 19110-1018
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Country | US
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Telephone | 267-692-2858
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Fax |
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Provider Business Mailing Address
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Address Line | 37 S RUBY ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3322
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Country | US
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Telephone | 601-862-0343
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JOURDAN MARIE PORTER
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Credential | PSYD MED
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Telephone | 601-862-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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