Provider Demographics
NPI:1023189057
Name:GORDON, MONYCA LYNN (LSW)
Entity type:Individual
Prefix:MRS
First Name:MONYCA
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SYMMES RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1844
Mailing Address - Country:US
Mailing Address - Phone:513-645-4578
Mailing Address - Fax:513-883-1546
Practice Address - Street 1:2052 PRINCETON RD
Practice Address - Street 2:TRANSITIONAL LIVING
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4746
Practice Address - Country:US
Practice Address - Phone:513-863-6383
Practice Address - Fax:513-863-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0010292104100000X
OHS10292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health