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General NPI Number Information
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NPI Number | 1508317363
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Entity Type | Individual
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Provider Name | MR. THOMAS W GORDON
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Gender | Male
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 107 MINERAL SPRINGS RD
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City | HIGHLAND MILLS
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State | NY
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Zip | 10930-6228
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Country | US
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Telephone | 914-924-1598
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Fax |
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Provider Business Mailing Address
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Address Line | 249 MAIN STREET
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City | BEACON
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State | NY
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Zip | 12508
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Country | US
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Telephone | 845-756-2366
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9258350
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 32584
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License Number State | NY
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