Provider Demographics
NPI:1205822970
Name:GORDON, NANCY (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 KIRKWOOD HWY
Mailing Address - Street 2:SUTIE 104
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4857
Mailing Address - Country:US
Mailing Address - Phone:302-995-7001
Mailing Address - Fax:302-478-4455
Practice Address - Street 1:5700 KIRKWOOD HWY
Practice Address - Street 2:SUTIE 104
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4857
Practice Address - Country:US
Practice Address - Phone:302-995-7001
Practice Address - Fax:302-478-4455
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2100004151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE500609Medicare PIN