MEDICARE: MS. JUDY ELLEN GORDON L.M.H.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	000294	NY

General Provider Information

NPI Number	:	1013006410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY ELLEN GORDON L.M.H.C.

Provider Business Mailing Address
First Line	:	5006 DORSEY HALL DR
Second Line	:	C-2
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7737
Country	:	US
Telephone Number	:	443-604-2741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 DORSEY HALL DR
Second Line	:	C-2
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7737
Country	:	US
Telephone Number	:	443-604-2741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/11/2016

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