Provider Demographics
NPI:1063031946
Name:GORDON ROTHSCHILD, GWEN RACHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:RACHEL
Last Name:GORDON ROTHSCHILD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 TRAVIS RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:10505-2004
Mailing Address - Country:US
Mailing Address - Phone:914-262-6646
Mailing Address - Fax:
Practice Address - Street 1:250 E HARTSDALE AVE STE 23
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3574
Practice Address - Country:US
Practice Address - Phone:914-262-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0302495103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent