Provider Demographics
NPI:1043687825
Name:PATRICIA E. GORDON, LCSW-R, LLC
Entity type:Organization
Organization Name:PATRICIA E. GORDON, LCSW-R, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:203-733-8033
Mailing Address - Street 1:68 VIRGINIA AVE
Mailing Address - Street 2:#7
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5764
Mailing Address - Country:US
Mailing Address - Phone:203-733-8033
Mailing Address - Fax:203-612-2337
Practice Address - Street 1:68 VIRGINIA AVE
Practice Address - Street 2:#7
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5764
Practice Address - Country:US
Practice Address - Phone:203-733-8033
Practice Address - Fax:203-612-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD30069939OtherMEDICARE PTAN