Provider Demographics
NPI:1831673383
Name:GORDON, BETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 BURTS PIT RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3621
Mailing Address - Country:US
Mailing Address - Phone:413-297-6562
Mailing Address - Fax:
Practice Address - Street 1:34 POMEROY MEADOW RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9664
Practice Address - Country:US
Practice Address - Phone:413-527-0811
Practice Address - Fax:413-527-4795
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10195181041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool