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General NPI Number Information
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NPI Number | 1831602085
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Entity Type | Individual
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Provider Name | RAQUEL W GORDON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 1053 BUCHANAN ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-2712
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Country | US
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Telephone | 202-854-4889
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Fax |
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Provider Business Mailing Address
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Address Line | 16612 PEACH ST
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City | BOWIE
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State | MD
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Zip | 20716-3526
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Country | US
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Telephone | 301-356-6698
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 03284
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1877
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License Number State | DC
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