Provider Demographics
NPI:1124851845
Name:GORDON, GRIFFIN T (LMFT-A)
Entity type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:T
Last Name:GORDON
Suffix:
Gender:X
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MAPLE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5545
Mailing Address - Country:US
Mailing Address - Phone:202-808-1184
Mailing Address - Fax:
Practice Address - Street 1:156 MAPLE ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5545
Practice Address - Country:US
Practice Address - Phone:202-808-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist