Provider Demographics
NPI:1922567411
Name:GORDON, CHRISTINA ANNE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANNE
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DONATO DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2751
Mailing Address - Country:US
Mailing Address - Phone:774-259-2264
Mailing Address - Fax:
Practice Address - Street 1:12 DONATO DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2751
Practice Address - Country:US
Practice Address - Phone:774-259-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician