MEDICARE: DR. ADAMI GORDON PSYD

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	106H00000X	Marriage & Family Therapist
2	103T00000X	Psychologist	023907	NY

General Provider Information

NPI Number	:	1679092928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAMI GORDON PSYD

Provider Business Mailing Address
First Line	:	425 E 26TH ST APT 5D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7748
Country	:	US
Telephone Number	:	626-298-1709
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E 26TH ST APT 5D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7748
Country	:	US
Telephone Number	:	626-298-1709
Fax Number	:

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	11/19/2020

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