Provider Demographics
NPI:1447526827
Name:GORDON, DONNA M (MSW)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 STONEHAM DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2250
Mailing Address - Country:US
Mailing Address - Phone:860-983-1460
Mailing Address - Fax:
Practice Address - Street 1:26 STONEHAM DR
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2250
Practice Address - Country:US
Practice Address - Phone:860-983-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1067771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical