Provider Demographics
NPI:1780820167
Name:GORDON, H (HELEN) GAIL (MA)
Entity Type:Individual
Prefix:
First Name:H (HELEN)
Middle Name:GAIL
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SAINT PAUL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5147
Mailing Address - Country:US
Mailing Address - Phone:617-731-5683
Mailing Address - Fax:617-277-0657
Practice Address - Street 1:109 SAINT PAUL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5147
Practice Address - Country:US
Practice Address - Phone:617-731-5683
Practice Address - Fax:617-277-0657
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1220103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist