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General NPI Number Information
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NPI Number | 1376945915
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Entity Type | Individual
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Provider Name | JAMES ANTONIO GORDON PH.D
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Gender | Male
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 11341 FARMERS BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2425
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Country | US
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Telephone | 914-258-7547
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Fax |
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Provider Business Mailing Address
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Address Line | 11341 FARMERS BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2425
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Country | US
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Telephone | 914-258-7547
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | JG719654D
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | JG71501X
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License Number State | MS
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