Provider Demographics
NPI:1689554925
Name:HAMPSON, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RORY
Other - Middle Name:
Other - Last Name:HAMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:272 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1327
Mailing Address - Country:US
Mailing Address - Phone:904-553-5742
Mailing Address - Fax:
Practice Address - Street 1:1340 SOLDIERS FIELD RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1000
Practice Address - Country:US
Practice Address - Phone:617-334-2808
Practice Address - Fax:617-334-7971
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker