Provider Demographics
NPI:1013706795
Name:GORDON, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GORDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIVER BIRCH CT APT 433
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5138
Mailing Address - Country:US
Mailing Address - Phone:321-805-0079
Mailing Address - Fax:
Practice Address - Street 1:600 RIVER BIRCH CT APT 433
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5138
Practice Address - Country:US
Practice Address - Phone:321-805-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician