Provider Demographics
NPI:1326897521
Name:GORDON, KAI (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JEFFERSON ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5051
Mailing Address - Country:US
Mailing Address - Phone:973-634-2465
Mailing Address - Fax:
Practice Address - Street 1:1 FOREST CT
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2514
Practice Address - Country:US
Practice Address - Phone:973-722-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst