Ellen J Gordon Licensed Master Social Worker PC
Social Worker, Clinical in Port Jefferson Station, NY. Organization (NPI-2).
NPI number1295367019
StatusActive
Last updated in NPPESMar 9, 2022
Details
- NPI
- 1295367019
- Entity type
- Organization (NPI-2)
- Legal business name
- Ellen J Gordon Licensed Master Social Worker PC
- Organization subpart
- No
- Enumeration date
- Feb 10, 2020
- Certification date
- Mar 9, 2022
- Last updated
- Mar 9, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
Practice location
8 Roosevelt AvePort Jefferson Station, NY 11776-3337
Phone 631-736-7707
Mailing address
507 Empire AveWest Babylon, NY 11704-3306
Phone 631-649-6278
Authorized official
Ellen Gordon
Lcsw
6316496278
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