Provider Demographics
NPI:1760981864
Name:GORDON, MARGARET ANN (CASAC-T)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2430
Mailing Address - Country:US
Mailing Address - Phone:845-856-6344
Mailing Address - Fax:845-856-4091
Practice Address - Street 1:17 SUSSEX ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2430
Practice Address - Country:US
Practice Address - Phone:845-856-6344
Practice Address - Fax:845-856-4091
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33529101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)