Provider Demographics
NPI:1396244596
Name:GORDON, ROSA MARY (MSW)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:MARY
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5356
Mailing Address - Country:US
Mailing Address - Phone:954-439-8832
Mailing Address - Fax:
Practice Address - Street 1:7524 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5356
Practice Address - Country:US
Practice Address - Phone:954-439-8832
Practice Address - Fax:954-439-8832
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health