Healthcare Provider Details

I. General information

NPI: 1104564483
Provider Name (Legal Business Name): ELIZABETH MARIE GORDON MSW, LCSW, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 E EXPOSITION AVE
AURORA CO
80012-2623
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924342
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: