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NPI Code Detail

MEDICARE: LYNN GORDON RCSWI

MEDICARE: LYNN GORDON RCSWI
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
11041C0700XClinical Social WorkerRCSWI12682FL
21041C0700XClinical Social WorkerSW17895FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225665334
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN GORDON RCSWI
Provider Business Mailing Address
First Line : 1152 N UNIVERSITY DR
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33024-5000
Country : US
Telephone Number : 954-639-7345
Fax Number : 954-639-7433
Provider Business Practice Location Address
First Line : 1152 N UNIVERSITY DR
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33024-5000
Country : US
Telephone Number : 954-639-7345
Fax Number : 954-639-7433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2020
Last Update Date : 05/03/2024

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Directions to “ LYNN GORDON RCSWI” Practice Location

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