Provider Demographics
NPI:1881791267
Name:GORDON, SHAWN MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:MICHELLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 WILES RD STE 339
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2036
Mailing Address - Country:US
Mailing Address - Phone:954-341-7774
Mailing Address - Fax:954-903-1650
Practice Address - Street 1:7401 WILES RD STE 339
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2036
Practice Address - Country:US
Practice Address - Phone:954-341-7774
Practice Address - Fax:954-903-1650
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8335103TC2200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7676948Medicaid