Provider Demographics
NPI:1669956785
Name:GORDON, ZACHARY (LCSW-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 WISCONSIN AVE NW APT 211
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4634
Mailing Address - Country:US
Mailing Address - Phone:301-252-1610
Mailing Address - Fax:
Practice Address - Street 1:4905 DEL RAY AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2527
Practice Address - Country:US
Practice Address - Phone:301-252-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical