Provider Demographics
NPI:1083420426
Name:GORDON, ARLENE BRETT
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:BRETT
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9648 NW 7TH CIR APT 1923
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4998
Mailing Address - Country:US
Mailing Address - Phone:954-292-8733
Mailing Address - Fax:
Practice Address - Street 1:9648 NW 7TH CIR APT 1923
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4998
Practice Address - Country:US
Practice Address - Phone:954-292-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health