Provider Demographics
NPI:1336505957
Name:GORDON, ELIZABETH AMY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:AMY
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 WALNUT ST
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4708
Mailing Address - Country:US
Mailing Address - Phone:267-225-7579
Mailing Address - Fax:
Practice Address - Street 1:1845 WALNUT ST
Practice Address - Street 2:15TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4708
Practice Address - Country:US
Practice Address - Phone:267-225-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017992103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral