Provider Demographics
NPI:1386775104
Name:GORDON, ALAN T (LCSW)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:T
Last Name:GORDON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 VIA MARINA # 1302
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5385
Mailing Address - Country:US
Mailing Address - Phone:310-945-6811
Mailing Address - Fax:
Practice Address - Street 1:1247 7TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1644
Practice Address - Country:US
Practice Address - Phone:310-945-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical