Provider Demographics
NPI:1831273572
Name:GORDON, RUTH D (MA, MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:D
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 IMPERIAL GOLF COURSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1079
Mailing Address - Country:US
Mailing Address - Phone:239-692-8060
Mailing Address - Fax:239-692-8059
Practice Address - Street 1:1930 IMPERIAL GOLF COURSE BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1079
Practice Address - Country:US
Practice Address - Phone:239-692-8060
Practice Address - Fax:239-692-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65951041C0700X
MA10215011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical