MEDICARE: DR. DENISE GORDON PSY.D., M.F.T.

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	106H00000X	Marriage & Family Therapist	MFT22922	CA

General Provider Information

NPI Number	:	1811326358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE GORDON PSY.D., M.F.T.

Provider Business Mailing Address
First Line	:	462 N. LINDEN DRIVE
Second Line	:	SUITE 246
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2203
Country	:	US
Telephone Number	:	310-858-8661
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 N. LINDEN DRIVE
Second Line	:	SUITE 246
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2203
Country	:	US
Telephone Number	:	310-858-8661
Fax Number	:

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

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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