Provider Demographics
NPI:1518697408
Name:GORDON, DARRYEL J (RMA, CASAC TRAINED)
Entity Type:Individual
Prefix:
First Name:DARRYEL
Middle Name:J
Last Name:GORDON
Suffix:
Gender:M
Credentials:RMA, CASAC TRAINED
Other - Prefix:
Other - First Name:DARRYEL
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RMA, CASAC TRAINED
Mailing Address - Street 1:7410 RIDGE BLVD APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2336
Mailing Address - Country:US
Mailing Address - Phone:192-923-2279
Mailing Address - Fax:
Practice Address - Street 1:249 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4946
Practice Address - Country:US
Practice Address - Phone:192-923-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)