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NPI Code Detail

MEDICARE: PATRICK V GORDON LICSW

MEDICARE: PATRICK V 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
11041C0700XClinical Social Worker1020923MA

General Provider Information

NPI Number : 1760587224
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK V GORDON LICSW
Provider Business Mailing Address
First Line : 12 GLEN DEVIN ST
Second Line :
City : AMESBURY
State : MA
Zip : 01913-1443
Country : US
Telephone Number : 978-388-6944
Fax Number :
Provider Business Practice Location Address
First Line : 116 SUMMER ST
Second Line :
City : HAVERHILL
State : MA
Zip : 01830-6032
Country : US
Telephone Number : 781-871-6550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 07/08/2007

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Directions to “ PATRICK V GORDON LICSW” Practice Location

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