| Gregory P. Gordon,lcsw,inc. | |
|
1101 Lincoln Ave Evansville IN 47714-1028 | |
| (812) 455-3203 | |
| (812) 401-3090 |
| Full Name | Gregory P. Gordon,lcsw,inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1101 Lincoln Ave, Evansville, Indiana |
| Authorized Official Name and Position | Gregory Peter Gordon (PRESIDENT) |
| Authorized Official Contact | 8124553203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory P. Gordon,lcsw,inc. 1101 Lincoln Ave Evansville IN 47714-1028 Ph: (812) 455-3203 | Gregory P. Gordon,lcsw,inc. 1101 Lincoln Ave Evansville IN 47714-1028 Ph: (812) 455-3203 |
| NPI Number | 1669666046 |
|---|---|
| Provider Enumeration Date | 08/29/2007 |
| Last Update Date | 08/29/2007 |
| Medicare PECOS PAC ID | 7618060872 |
|---|---|
| Medicare Enrollment ID | O20070904000271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669666046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 34002553A (Indiana) | Primary |
| Provider Name | Gregory P Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467492546 PECOS PAC ID: 9638061252 Enrollment ID: I20040329000314 |
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