Provider Demographics
NPI:1295861854
Name:GORDON, ANDREA BRIGET (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:BRIGET
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2651
Mailing Address - Country:US
Mailing Address - Phone:562-208-1985
Mailing Address - Fax:562-342-6607
Practice Address - Street 1:316 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2651
Practice Address - Country:US
Practice Address - Phone:562-208-1985
Practice Address - Fax:562-342-6607
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist