Healthcare Provider Details

I. General information

NPI: 1588993117
Provider Name (Legal Business Name): SHARON M GORDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N STATE RT 17 SUITE 313
PARAMUS NJ
07652-2644
US

IV. Provider business mailing address

225 RICHARD CT
POMONA NY
10970-2305
US

V. Phone/Fax

Practice location:
  • Phone: 201-783-5256
  • Fax:
Mailing address:
  • Phone: 845-517-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05220000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: