Provider Demographics
NPI:1124627666
Name:GORDON, KIMBERLY (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SHEEHAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:CT
Mailing Address - Zip Code:06777-1008
Mailing Address - Country:US
Mailing Address - Phone:914-424-0229
Mailing Address - Fax:
Practice Address - Street 1:24 SHEEHAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:CT
Practice Address - Zip Code:06777-1008
Practice Address - Country:US
Practice Address - Phone:914-523-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health