MEDICARE: MS. GERALDINE M GORDON

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

General Provider Information

NPI Number	:	1427845205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GERALDINE M GORDON

Provider Business Mailing Address
First Line	:	501 E 165TH ST APT 5A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6651
Country	:	US
Telephone Number	:	917-526-5329
Fax Number	:	917-526-5329

Provider Business Practice Location Address
First Line	:	130 E 177TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-5902
Country	:	US
Telephone Number	:	212-665-1860
Fax Number	:

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

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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