Provider Demographics
NPI:1225045511
Name:GORDON, STEVEN (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 113TH ST
Mailing Address - Street 2:APT 2 I
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5635
Mailing Address - Country:US
Mailing Address - Phone:718-575-2186
Mailing Address - Fax:
Practice Address - Street 1:646 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5426
Practice Address - Country:US
Practice Address - Phone:646-402-5363
Practice Address - Fax:631-543-8573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0491231041C0700X
NY049123R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN53OV1Medicare ID - Type Unspecified
NYN2M871Medicare ID - Type Unspecified