Healthcare Provider Details

I. General information

NPI: 1154866333
Provider Name (Legal Business Name): SAMANTHA GORDIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1403
SILVER SPRING MD
20915-1403
US

IV. Provider business mailing address

PO BOX 1403
SILVER SPRING MD
20915-1403
US

V. Phone/Fax

Practice location:
  • Phone: 240-406-7792
  • Fax: 301-307-5871
Mailing address:
  • Phone: 240-406-7792
  • Fax: 301-307-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011451
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081470
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: