Provider Demographics
NPI:1346799970
Name:GORDON, AISHA (MSW)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
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 1:435 CLARK RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5596
Mailing Address - Country:US
Mailing Address - Phone:904-765-0665
Mailing Address - Fax:904-765-0664
Practice Address - Street 1:435 CLARK RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5596
Practice Address - Country:US
Practice Address - Phone:904-765-0665
Practice Address - Fax:904-765-0664
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical