Healthcare Provider Details

I. General information

NPI: 1528662244
Provider Name (Legal Business Name): JOYETTA GORDON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 SUTPHIN BLVD STE 5
JAMAICA NY
11435-3648
US

IV. Provider business mailing address

9027 SUTPHIN BLVD STE 5
JAMAICA NY
11435-3648
US

V. Phone/Fax

Practice location:
  • Phone: 718-530-4530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: