Healthcare Provider Details

I. General information

NPI: 1538095989
Provider Name (Legal Business Name): MAGDALENA S GORDON RIMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAGGIE GORDON RIMH

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 MIDSUMMER DR
WINDERMERE FL
34786-8324
US

IV. Provider business mailing address

2709 MIDSUMMER DR
WINDERMERE FL
34786-8324
US

V. Phone/Fax

Practice location:
  • Phone: 321-438-5953
  • Fax:
Mailing address:
  • Phone: 321-438-5953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: