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General NPI Number Information
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NPI Number | 1336505957
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Entity Type | Individual
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Provider Name | ELIZABETH AMY GORDON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 1845 WALNUT ST 15TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4708
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Country | US
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Telephone | 267-225-7579
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 WALNUT ST 15TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4708
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Country | US
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Telephone | 267-225-7579
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PS017992
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017992
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License Number State | PA
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