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General NPI Number Information
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NPI Number | 1619360385
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Entity Type | Organization
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Legal Business Name | ELSIE M. GORDON, PH.D., LLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 13-15 E DEER PARK DR STE 103D
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2070
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Country | US
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Telephone | 240-750-8847
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Fax |
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Provider Business Mailing Address
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Address Line | 13-15 E DEER PARK DR STE 103D
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2070
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Country | US
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Telephone | 240-750-8847
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ELSIE MANAGBANAG GORDON
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Credential | PH.D.
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Telephone | 240-750-8847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04451
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License Number State | MD
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