Provider Demographics
NPI:1154866333
Name:GORDIN, SAMANTHA (LICSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GORDIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONNECTICUT AVE NW STE 602
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1716
Mailing Address - Country:US
Mailing Address - Phone:240-406-7792
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 602
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1716
Practice Address - Country:US
Practice Address - Phone:240-406-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040114511041C0700X
DCLC500814701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical