Provider Demographics
NPI:1699831537
Name:GORDON, JOAN INGBER (LCSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:INGBER
Last Name:GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:INGBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:180 WEST END AVENUE
Mailing Address - Street 2:10E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4940
Mailing Address - Country:US
Mailing Address - Phone:212-724-4957
Mailing Address - Fax:
Practice Address - Street 1:156 FIFTH AVENUE
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-724-4957
Practice Address - Fax:212-243-4511
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072555611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPOB072556OtherMETRO PLUS
NYN42V51Medicare ID - Type Unspecified