Healthcare Provider Details

I. General information

NPI: 1639538689
Provider Name (Legal Business Name): DEBORAH GORDIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 OLNEY SANDY SPRING RD STE A
OLNEY MD
20832-1587
US

IV. Provider business mailing address

5210 WAPAKONETA RD
BETHESDA MD
20816-3127
US

V. Phone/Fax

Practice location:
  • Phone: 301-758-7755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21567
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: