Provider Demographics
NPI:1578770715
Name:GORDON, SIMONE (DSW)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST END AVENUE
Mailing Address - Street 2:5P
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-794-3853
Mailing Address - Fax:
Practice Address - Street 1:30 EAST END AVENUE
Practice Address - Street 2:5P
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-794-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024546 R LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical