Provider Demographics
NPI:1811603053
Name:GORDON, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FULLER PL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2929
Mailing Address - Country:US
Mailing Address - Phone:585-626-2480
Mailing Address - Fax:
Practice Address - Street 1:UR/NOYES MENTAL HEALTH & WELLNESS
Practice Address - Street 2:5712 TEC DRIVE
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414
Practice Address - Country:US
Practice Address - Phone:585-658-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health