MEDICARE: GLORIA L 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
1	1041C0700X	Clinical Social Worker	SW8240	FL

General Provider Information

NPI Number	:	1225251010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA L GORDON LCSW

Provider Business Mailing Address
First Line	:	132 SARATOGA BLVD W
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-8263
Country	:	US
Telephone Number	:	561-798-9483
Fax Number	:

Provider Business Practice Location Address
First Line	:	11903 SOUTHERN BLVD STE 216
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-422-3314
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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