Provider Demographics
NPI:1205687944
Name:GORDON, PATRICIA HOLLY
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HOLLY
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 1:125 AMHERST LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5804
Mailing Address - Country:US
Mailing Address - Phone:631-312-1409
Mailing Address - Fax:
Practice Address - Street 1:125 AMHERST LN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5804
Practice Address - Country:US
Practice Address - Phone:631-312-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician