MEDICARE: GORDON SCHWARTZ M.A.

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1780442715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON SCHWARTZ M.A.

Provider Business Mailing Address
First Line	:	2233 E HIGHLAND AVE UNIT 129
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4878
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13615 N 35TH AVE STE 8-12
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-1243
Country	:	US
Telephone Number	:	248-299-0030
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	03/13/2024

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