MEDICARE: MS. SUSAN M GORDON LICSW

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	1041C0700X	Clinical Social Worker	1675	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	110364	OTHER	NH	MERIDIAN

General Provider Information

NPI Number	:	1730522913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN M GORDON LICSW

Provider Business Mailing Address
First Line	:	609 PORTSMOUTH AVE # 304
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-9998
Country	:	US
Telephone Number	:	603-207-2197
Fax Number	:	603-377-8425

Provider Business Practice Location Address
First Line	:	330 PORTSMOUTH AVE
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2220
Country	:	US
Telephone Number	:	603-207-2197
Fax Number	:	603-377-8425

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	07/30/2025

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