Provider Demographics
NPI:1760016232
Name:GORDON, LAURA ANN (MACC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MARKEL RD
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1121
Mailing Address - Country:US
Mailing Address - Phone:484-951-4868
Mailing Address - Fax:
Practice Address - Street 1:526 MARKEL RD
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1121
Practice Address - Country:US
Practice Address - Phone:484-951-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor