MEDICARE: SAMANTHA GORDON LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	27338	MD

General Provider Information

NPI Number	:	1063199511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA GORDON LMSW

Provider Business Mailing Address
First Line	:	1208 STEVENAGE CT
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1265
Country	:	US
Telephone Number	:	443-916-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	900A S MAIN ST STE 103
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-5438
Country	:	US
Telephone Number	:	443-377-5963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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