MEDICARE: ARIANA GORDON LPC, LCADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00355500	NJ
2	101YP2500X	Professional Counselor	37PC00857800	NJ

General Provider Information

NPI Number	:	1790413797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIANA GORDON LPC, LCADC

Provider Business Mailing Address
First Line	:	13 VERMEER DR APT 20
Second Line	:
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-2346
Country	:	US
Telephone Number	:	732-877-4348
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 VERMEER DR APT 20
Second Line	:
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-2346
Country	:	US
Telephone Number	:	732-877-4348
Fax Number	:

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

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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