Provider Demographics
NPI:1558819938
Name:GORDON, REUVEN HARRIS
Entity type:Individual
Prefix:
First Name:REUVEN
Middle Name:HARRIS
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MILLWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3775
Mailing Address - Country:US
Mailing Address - Phone:508-380-7848
Mailing Address - Fax:
Practice Address - Street 1:115 MILLWOOD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3775
Practice Address - Country:US
Practice Address - Phone:508-380-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health