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General NPI Number Information
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NPI Number | 1669956785
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Entity Type | Individual
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Provider Name | ZACHARY GORDON LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 4905 DEL RAY AVE
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City | BETHESDA
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State | MD
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Zip | 20814-2527
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Country | US
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Telephone | 301-252-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 WISCONSIN AVE NW APT 211
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City | WASHINGTON
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State | DC
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Zip | 20007-4634
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Country | US
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Telephone | 301-252-1610
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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 | 16307
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License Number State | MD
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