Eitan M Gordon, Ed.S.
Psychologist, School in Lebanon, IN. Individual provider (NPI-1).
NPI number1417455452
StatusActive
Last updated in NPPESOct 28, 2024
Details
- NPI
- 1417455452
- Entity type
- Individual (NPI-1)
- Name
- Mr. Eitan M Gordon
- Credential
- Ed.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 24, 2018
- Certification date
- Oct 28, 2024
- Last updated
- Oct 28, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TS0200X | Psychologist, School | 10283464 | IN | Yes |
Practice location
1810 N Grant StLebanon, IN 46052-1242
Phone 773-742-2487
Mailing address
1810 N Grant StLebanon, IN 46052-1242
Phone 765-483-3090 · Fax 765-483-3087
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