Doctor Name: | MR. JOHN JOSEPH GORDON, |
NPI Number: | 1023406030 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC, ICADC |
License Number: | |
Business Practice Address: | 68 Virginia Ave Unit 7 Danbury, CT - 068105764 |
Business Phone Number: | 9173092067 |
Business Fax Number: | |
Mailing Address: | 68 Virginia Ave, Unit 7 DANBURY |
State: | CT |
Postal Code: | 068105764 |
Phone Number: | 9173092067 |
Fax Number: | |
NPI Enumeration Date: | 12/26/2014 |
NPI Last Update Date: | 12/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |