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General NPI Number Information
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NPI Number | 1073762704
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Entity Type | Individual
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Provider Name | KELLY VERONICA GORDON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 18947 JOHN J WILLIAMS HWY UNIT 212
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4476
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Country | US
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Telephone | 302-567-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 18947 JOHN J WILLIAMS HWY UNIT 212
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4476
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Country | US
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Telephone | 302-567-8331
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Fax | 302-645-5041
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q1-0001511
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18338
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License Number State | MD
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