Healthcare Provider Details

I. General information

NPI: 1063713022
Provider Name (Legal Business Name): KAREN GORDON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21528 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1831
US

IV. Provider business mailing address

21528 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1831
US

V. Phone/Fax

Practice location:
  • Phone: 718-425-0907
  • Fax: 718-228-8601
Mailing address:
  • Phone: 718-425-0907
  • Fax: 718-228-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number018807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: