Provider Demographics
NPI:1952428500
Name:GORDON, LAUREN STEPHANIE (MSW, LSCW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:STEPHANIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW, LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HALF CIRCLE RD EXT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5233
Mailing Address - Country:US
Mailing Address - Phone:917-656-6047
Mailing Address - Fax:
Practice Address - Street 1:110 HALF CIRCLE RD EXT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-5233
Practice Address - Country:US
Practice Address - Phone:917-656-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026297-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical