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General NPI Number Information
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NPI Number | 1942306675
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Entity Type | Individual
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Provider Name | CLIFFORD I GORDON ED.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 36 BRIDGE WAY
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City | PASCOAG
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State | RI
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Zip | 02859-3131
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Country | US
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Telephone | 401-568-7661
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Fax | 401-245-5762
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Provider Business Mailing Address
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Address Line | 18 OLD CHIMNEY RD
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City | BARRINGTON
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State | RI
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Zip | 02806-3243
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Country | US
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Telephone | 401-247-2798
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Fax | 401-245-5762
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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 | PS00331
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License Number State | RI
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