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NPI Code Detail

MEDICARE: REUVEN HARRIS GORDON

MEDICARE: REUVEN HARRIS 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1558819938
Entity Type Code : Individual
Provider Name (Legal Business Name) : REUVEN HARRIS GORDON
Provider Business Mailing Address
First Line : PO BOX 1595
Second Line :
City : MIDDLETOWN
State : CT
Zip : 06457-8095
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10 FERRY ST STE 313
Second Line :
City : CONCORD
State : NH
Zip : 03301-5004
Country : US
Telephone Number : 860-788-6404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2016
Last Update Date : 12/02/2025

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Directions to “ REUVEN HARRIS GORDON ” Practice Location

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