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General NPI Number Information
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NPI Number | 1356040356
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Entity Type | Organization
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Legal Business Name | TOM GORDON LCSW THERAPY, PLLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 45 JOHN STREET
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City | GOSHEN
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State | NY
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Zip | 10924-1092
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Country | US
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Telephone | 914-810-3177
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 WHISPERING HLS
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City | CHESTER
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State | NY
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Zip | 10918-1555
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Country | US
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Telephone | 914-810-3317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS WAYNE GORDON
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Credential | LCSW
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Telephone | 914-924-1598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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