Provider Demographics
NPI:1124900816
Name:GORDONEL, HARRY L (CASAC T / CPRA)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:L
Last Name:GORDONEL
Suffix:
Gender:M
Credentials:CASAC T / CPRA
Other - Prefix:MR
Other - First Name:HARRY
Other - Middle Name:L
Other - Last Name:GORDONEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC T / CPRA
Mailing Address - Street 1:15 FORTUNE RD W
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1625
Mailing Address - Country:US
Mailing Address - Phone:845-281-4393
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE RD W
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1625
Practice Address - Country:US
Practice Address - Phone:845-281-4393
Practice Address - Fax:845-692-2889
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35161101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)