Provider Demographics
NPI:1700298999
Name:GORDON, LEAH CHRISTINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:CHRISTINE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LICSW
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 127
Mailing Address - Street 2:708 KURN HATTIN RD
Mailing Address - City:WESTMINSTER
Mailing Address - State:VT
Mailing Address - Zip Code:05158-0127
Mailing Address - Country:US
Mailing Address - Phone:802-722-3336
Mailing Address - Fax:802-722-3174
Practice Address - Street 1:708 KURN HATTIN RD
Practice Address - Street 2:KURN HATTIN HOMES
Practice Address - City:WESTMINSTER
Practice Address - State:VT
Practice Address - Zip Code:05158-0127
Practice Address - Country:US
Practice Address - Phone:802-722-3336
Practice Address - Fax:802-722-3174
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900010961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical