Provider Demographics
NPI:1689138653
Name:GORDONSON, RENA ESTHER (LSW)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:ESTHER
Last Name:GORDONSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C12 GIRARD PL APT 12C
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5626
Mailing Address - Country:US
Mailing Address - Phone:646-584-7785
Mailing Address - Fax:
Practice Address - Street 1:425 AMWELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1213
Practice Address - Country:US
Practice Address - Phone:908-770-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06437000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker