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General NPI Number Information
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NPI Number | 1386775104
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Entity Type | Individual
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Provider Name | ALAN T GORDON LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 1247 7TH ST STE 300
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City | SANTA MONICA
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State | CA
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Zip | 90401-1644
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Country | US
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Telephone | 310-945-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 4139 VIA MARINA # 1302
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5385
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Country | US
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Telephone | 310-945-6811
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25632
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License Number State | CA
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