Healthcare Provider Details

I. General information

NPI: 1023189057
Provider Name (Legal Business Name): MONYCA LYNN GORDON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 PRINCETON RD TRANSITIONAL LIVING
HAMILTON OH
45011-4746
US

IV. Provider business mailing address

1020 SYMMES RD
FAIRFIELD OH
45014-1844
US

V. Phone/Fax

Practice location:
  • Phone: 513-863-6383
  • Fax: 513-863-9882
Mailing address:
  • Phone: 513-645-4578
  • Fax: 513-883-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0010292
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: