Provider Demographics
NPI:1609359074
Name:GORDON, LENTY (MA, CAGS, LMHC)
Entity Type:Individual
Prefix:
First Name:LENTY
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MARCONI ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3901
Mailing Address - Country:US
Mailing Address - Phone:401-556-2688
Mailing Address - Fax:
Practice Address - Street 1:40 MARCONI ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3901
Practice Address - Country:US
Practice Address - Phone:401-556-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI103TP2701X
RIMHC01218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy