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General NPI Number Information
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NPI Number | 1902278070
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Entity Type | Individual
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Provider Name | HEATHER B. GORDON LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 425 ROBINSON ST
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City | BINGHAMTON
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State | NY
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Zip | 13904-1735
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Country | US
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Telephone | 607-773-4155
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Fax | 607-773-4417
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Provider Business Mailing Address
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Address Line | 425 ROBINSON ST
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City | BINGHAMTON
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State | NY
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Zip | 13904-1735
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Country | US
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Telephone | 607-763-2732
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Fax | 607-797-4315
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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 | R087697-01
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License Number State | NY
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