Healthcare Provider Details

I. General information

NPI: 1790440659
Provider Name (Legal Business Name): VALERIE E GORDON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 MERCER AVE
FARRELL PA
16121-2505
US

IV. Provider business mailing address

1914 MERCER AVE
FARRELL PA
16121-2505
US

V. Phone/Fax

Practice location:
  • Phone: 724-981-9815
  • Fax: 724-981-2293
Mailing address:
  • Phone: 724-981-9815
  • Fax: 724-981-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

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: