Provider Demographics
NPI:1407628837
Name:GOR, DOUGLAS ONYANGO SR
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ONYANGO
Last Name:GOR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1648
Mailing Address - Country:US
Mailing Address - Phone:845-454-8146
Mailing Address - Fax:845-454-8146
Practice Address - Street 1:57 BUCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1648
Practice Address - Country:US
Practice Address - Phone:845-454-8146
Practice Address - Fax:845-454-8146
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP050863-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical