Provider Demographics
NPI:1508518242
Name:COLLIER, GORDON HAKIM (LMSW)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:HAKIM
Last Name:COLLIER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 GEORGETTA DIX PLZ
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12307-1301
Mailing Address - Country:US
Mailing Address - Phone:518-881-6787
Mailing Address - Fax:
Practice Address - Street 1:327 GEORGETTA DIX PLZ
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12307-1301
Practice Address - Country:US
Practice Address - Phone:518-881-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker