Provider Demographics
NPI:1750722062
Name:GORDON, KERENSA DANIELA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KERENSA
Middle Name:DANIELA
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KERENSA
Other - Middle Name:DANIELA
Other - Last Name:GULLIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BACK
Mailing Address - Street 1:1401 NEW YORK AVE
Mailing Address - Street 2:APT 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1762
Mailing Address - Country:US
Mailing Address - Phone:718-287-1950
Mailing Address - Fax:
Practice Address - Street 1:858 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2927
Practice Address - Country:US
Practice Address - Phone:718-859-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443701101174H00000X
NY091284104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174H00000XOther Service ProvidersHealth Educator