Provider Demographics
NPI:1013925783
Name:GORDON, STEVEN MARK (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:GORDON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 GUILFORD RD STE 140
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2659
Mailing Address - Country:US
Mailing Address - Phone:410-988-2503
Mailing Address - Fax:410-343-7899
Practice Address - Street 1:8945 GUILFORD RD STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2659
Practice Address - Country:US
Practice Address - Phone:410-988-2503
Practice Address - Fax:410-343-7899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144658363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health