Provider Demographics
NPI:1164515938
Name:GORDON, STEPHANIE ELISE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELISE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 L ST # 406
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4106
Mailing Address - Country:US
Mailing Address - Phone:916-833-4349
Mailing Address - Fax:
Practice Address - Street 1:8912 VOLUNTEER LN STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3224
Practice Address - Country:US
Practice Address - Phone:916-368-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist