MEDICARE: MRS. SHAWN MICHELLE GORDON LCSW

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	103TC2200X	Clinical Child & Adolescent Psychologist	SW8335	FL
2	1041C0700X	Clinical Social Worker	SW8335	FL

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

General Provider Information

NPI Number	:	1881791267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWN MICHELLE GORDON LCSW

Provider Business Mailing Address
First Line	:	7401 WILES RD STE 339
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2036
Country	:	US
Telephone Number	:	954-341-7774
Fax Number	:	954-903-1650

Provider Business Practice Location Address
First Line	:	7401 WILES RD STE 339
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2036
Country	:	US
Telephone Number	:	954-341-7774
Fax Number	:	954-903-1650

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/21/2024

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