Provider Demographics
NPI:1275627291
Name:GORDON, JILLIAN ARROSA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ARROSA
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409-0312
Mailing Address - Country:US
Mailing Address - Phone:917-573-5072
Mailing Address - Fax:917-573-5072
Practice Address - Street 1:159 GREEN ST
Practice Address - Street 2:STE 23
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3736
Practice Address - Country:US
Practice Address - Phone:718-993-1400
Practice Address - Fax:718-993-0647
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0742611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical