Provider Demographics
NPI:1467273706
Name:GORDON, NATACHA (MHC)
Entity type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 HEADLEY TER FL 1
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1347
Mailing Address - Country:US
Mailing Address - Phone:917-744-7919
Mailing Address - Fax:
Practice Address - Street 1:74 HEADLEY TER FL 1
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1347
Practice Address - Country:US
Practice Address - Phone:917-744-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health