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General NPI Number Information
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NPI Number | 1467317404
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Entity Type | Individual
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Provider Name | CORY RAHEEM GORDY
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Gender | Male
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 4017 MINNESOTA AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3541
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Country | US
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Telephone | 202-388-9202
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Fax | 202-388-4339
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Provider Business Mailing Address
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Address Line | 805 CHANNING PL NE APT 412
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City | WASHINGTON
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State | DC
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Zip | 20018-1779
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Country | US
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Telephone | 205-777-8657
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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 | LG50082954
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License Number State | DC
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