Provider Demographics
NPI:1255983656
Name:GORDON-JAMES, ELAINE DENISE (LMSW, CASAC, CEAP)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:DENISE
Last Name:GORDON-JAMES
Suffix:
Gender:F
Credentials:LMSW, CASAC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1113
Mailing Address - Country:US
Mailing Address - Phone:718-310-9070
Mailing Address - Fax:
Practice Address - Street 1:200 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1113
Practice Address - Country:US
Practice Address - Phone:718-310-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071817-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker