Provider Demographics
NPI:1730522913
Name:GORDON, SUSAN M (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PORTSMOUTH AVE # 304
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-9998
Mailing Address - Country:US
Mailing Address - Phone:603-207-2197
Mailing Address - Fax:603-377-8425
Practice Address - Street 1:330 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2220
Practice Address - Country:US
Practice Address - Phone:603-207-2197
Practice Address - Fax:603-377-8425
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3087480Medicaid
ME1730522913Medicaid
NH110364OtherMERIDIAN
NH003409801Medicare PIN