Provider Demographics
NPI:1821146333
Name:GORDON, PATRICIA EVETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:EVETTE
Last Name: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 1:68 VIRGINIA AVENUE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:212-568-4484
Mailing Address - Fax:
Practice Address - Street 1:750 ASTOR AVENUE
Practice Address - Street 2:BRONX
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:212-568-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0777851041C0700X
CT0075141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical