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NPI Code Detail

MEDICARE: NANCY GORDON LCSW

MEDICARE: NANCY GORDON LCSW
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
11041C0700XClinical Social Worker210000415DE

General Provider Information

NPI Number : 1205822970
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY GORDON LCSW
Provider Business Mailing Address
First Line : 5700 KIRKWOOD HWY
Second Line : SUTIE 104
City : WILMINGTON
State : DE
Zip : 19808-4857
Country : US
Telephone Number : 302-995-7001
Fax Number : 302-478-4455
Provider Business Practice Location Address
First Line : 5700 KIRKWOOD HWY
Second Line : SUTIE 104
City : WILMINGTON
State : DE
Zip : 19808-4857
Country : US
Telephone Number : 302-995-7001
Fax Number : 302-478-4455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 07/11/2008

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