Provider Demographics
NPI:1568594075
Name:BALL, GORDON G (PHD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:G
Last Name:BALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 73RD ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2932
Mailing Address - Country:US
Mailing Address - Phone:212-957-3677
Mailing Address - Fax:212-787-4780
Practice Address - Street 1:25 CENTRAL PARK W APT 1I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7206
Practice Address - Country:US
Practice Address - Phone:212-957-3677
Practice Address - Fax:212-787-4780
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004919-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral