Provider Demographics
NPI:1417129412
Name:GORDON, ANN B (MA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CENTRAL PARK W
Mailing Address - Street 2:#2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8240
Mailing Address - Country:US
Mailing Address - Phone:212-222-2626
Mailing Address - Fax:
Practice Address - Street 1:372 CENTRAL PARK W
Practice Address - Street 2:#2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8240
Practice Address - Country:US
Practice Address - Phone:212-222-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003631-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health