Provider Demographics
NPI:1104029891
Name:GORDON, RISA SHERWOOD (MFT)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:SHERWOOD
Last Name:GORDON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6909
Mailing Address - Country:US
Mailing Address - Phone:310-837-6368
Mailing Address - Fax:310-837-3486
Practice Address - Street 1:3760 MOTOR AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6404
Practice Address - Country:US
Practice Address - Phone:310-837-6368
Practice Address - Fax:310-837-3486
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist