Provider Demographics
NPI:1376755801
Name:GORDON, ERAIN MARISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERAIN
Middle Name:MARISSA
Last Name:GORDON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ERAIN
Other - Middle Name:MARISSA
Other - Last Name:APPLEWHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3379 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3379 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1246
Practice Address - Country:US
Practice Address - Phone:609-228-3078
Practice Address - Fax:609-228-3083
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 016027103T00000X
NJ103TS0200X
NJ4728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist