Provider Demographics
NPI:1528295243
Name:GORDON, BONNIE GAIL (LCSW)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:GAIL
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 FLORES DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4022
Mailing Address - Country:US
Mailing Address - Phone:415-517-4081
Mailing Address - Fax:
Practice Address - Street 1:2275 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1662
Practice Address - Country:US
Practice Address - Phone:415-517-4081
Practice Address - Fax:415-864-1006
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212711041C0700X
CALCS212711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical