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General NPI Number Information
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NPI Number | 1386324572
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Entity Type | Individual
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Provider Name | TIMOTHY GORDON MSW
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Gender | Male
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 07/22/2023
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Provider Practice Location Address
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Address Line | 70 NORTH ST
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City | DANBURY
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State | CT
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Zip | 06810-5609
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Country | US
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Telephone | 914-222-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 29 LAKEVIEW RD
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City | NORTH SALEM
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State | NY
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Zip | 10560-2910
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Country | US
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Telephone | 914-355-0004
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7828
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License Number State | CT
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