MEDICARE: NICOLE 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	098808	NY
2	1041C0700X	Clinical Social Worker	SW22854	FL

General Provider Information

NPI Number	:	1598330615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE GORDON LCSW

Provider Business Mailing Address
First Line	:	626 N ALAFAYA TRL STE 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:	863-420-5499
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 N ALAFAYA TRL STE 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:	407-490-4520
Fax Number	:

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

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	03/24/2026

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