Provider Demographics
NPI:1619360385
Name:ELSIE M. GORDON, PH.D., LLC
Entity Type:Organization
Organization Name:ELSIE M. GORDON, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:MANAGBANAG
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-750-8847
Mailing Address - Street 1:13-15 E DEER PARK DR STE 103D
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2070
Mailing Address - Country:US
Mailing Address - Phone:240-750-8847
Mailing Address - Fax:
Practice Address - Street 1:13-15 E DEER PARK DR STE 103D
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2070
Practice Address - Country:US
Practice Address - Phone:240-750-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty