Provider Demographics
NPI:1518053578
Name:GORDON, JUNE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 GRAVENSTEIN HWY S
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4838
Mailing Address - Country:US
Mailing Address - Phone:707-484-8936
Mailing Address - Fax:707-829-2471
Practice Address - Street 1:1741 GRAVENSTEIN HWY S
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4838
Practice Address - Country:US
Practice Address - Phone:707-484-8936
Practice Address - Fax:707-829-2471
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA154550Medicare ID - Type Unspecified