Provider Demographics
NPI:1780576132
Name:GORDON, CYNTHIA THAWANA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:THAWANA
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3611
Mailing Address - Country:US
Mailing Address - Phone:929-393-5758
Mailing Address - Fax:
Practice Address - Street 1:857 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3611
Practice Address - Country:US
Practice Address - Phone:929-393-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst