Provider Demographics
NPI:1427845205
Name:GORDON, GERALDINE M
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:M
Last Name:GORDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 165TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6651
Mailing Address - Country:US
Mailing Address - Phone:917-526-5329
Mailing Address - Fax:917-526-5329
Practice Address - Street 1:130 E 177TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5902
Practice Address - Country:US
Practice Address - Phone:212-665-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health