Healthcare Provider Details

I. General information

NPI: 1861329534
Provider Name (Legal Business Name): MADELINE GORDON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST FL 7
NEW YORK NY
10018-2904
US

IV. Provider business mailing address

333 W END AVE
NEW YORK NY
10023-8128
US

V. Phone/Fax

Practice location:
  • Phone: 929-596-4451
  • Fax:
Mailing address:
  • Phone: 917-566-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: