Basic Information
| Provider Information | |||||||||
| NPI: | 1417206178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M. ED, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 N SILVER LN | ||||||||
| Address2: | |||||||||
| City: | SUNDERLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013759566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135129350 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 78 POMEROY TER | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135841310 | ||||||||
| FaxNumber: | 4135861490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2012 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.