Provider Demographics
NPI:1952820508
Name:GORDON, ROCHELLE JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:JILL
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:JILL
Other - Last Name:HAUSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:23 LONGACRE DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2250
Mailing Address - Country:US
Mailing Address - Phone:973-818-6496
Mailing Address - Fax:
Practice Address - Street 1:222 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1299
Practice Address - Country:US
Practice Address - Phone:888-724-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC044073001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical