Provider Demographics
NPI:1518152933
Name:GORDON, STUART (MSW, LCSW,CADC)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MSW, LCSW,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E PLUMB LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3540
Mailing Address - Country:US
Mailing Address - Phone:775-329-0623
Mailing Address - Fax:775-337-2971
Practice Address - Street 1:575 E PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3540
Practice Address - Country:US
Practice Address - Phone:775-329-0623
Practice Address - Fax:775-337-2971
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2725-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509379Medicaid