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General NPI Number Information
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NPI Number | 1053132415
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Entity Type | Individual
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Provider Name | DR. JULIE GORDON
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 125 N COURT ST
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City | WESTMINSTER
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State | MD
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Zip | 21157-5192
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Country | US
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Telephone | 410-751-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 18 FARNHAM WAY
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City | LUTHERVILLE TIMONIUM
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State | MD
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Zip | 21093-7474
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Country | US
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Telephone | 443-841-4614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | CER-173331-V3Q7B4
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License Number State | MD
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