Provider Demographics
NPI:1659496651
Name:MARKS GORDON, ELINOR JILL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELINOR
Middle Name:JILL
Last Name:MARKS GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 SHADYGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1641
Mailing Address - Country:US
Mailing Address - Phone:818-509-8365
Mailing Address - Fax:
Practice Address - Street 1:8838 W PICO BLVD
Practice Address - Street 2:PICO ROBERTSON ST CTR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3302
Practice Address - Country:US
Practice Address - Phone:310-271-3306
Practice Address - Fax:310-550-8381
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS19123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker