Provider Demographics
NPI:1285771246
Name:VAN GORDEN, HELEN ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:HELEN
Middle Name:ELIZABETH
Last Name:VAN GORDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:VAN GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:83 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1702
Mailing Address - Country:US
Mailing Address - Phone:207-772-4789
Mailing Address - Fax:
Practice Address - Street 1:83 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1702
Practice Address - Country:US
Practice Address - Phone:207-772-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC009341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME008423OtherANTHEM BC BS