Elsie Managbanag Gordon, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

04451 Issued in MD

Practice address

13-15 E Deer Park Dr
Ste 103D
Gaithersburg, MD 20877-2082

Phone

(240) 686-6885

Fax

(240) 686-6886

NPI assigned

Mar 17, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elsie M. Gordon, PH.D., LLC

  • Psychologist
  • Gaithersburg, MD
  • NPI 1619360385

  DC

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1003875246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13-15 E DEER PARK DR",
            "address_2": "STE 103D",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772082",
            "telephone_number": "240-686-6885",
            "fax_number": "240-686-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13-15 E DEER PARK DR",
            "address_2": "STE 103D",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772082",
            "telephone_number": "240-686-6885",
            "fax_number": "240-686-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ELSIE",
        "middle_name": "MANAGBANAG",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "04451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxim Alexander Goohs
• Anna Marie Gordin, LCSW C
• Gordon Center for General and Advanced Denistry, LLC
• Christy Elaine Gordon, M.S. LCPC
• David Charles Gordon, DDS
• Erika L Gordon, MSW
• Leonard Steven Gordon, D.D.S.
• Taja Gordon
• John Gotlewski, PSY.D.
• Herbert Bennett Gould, M.D.

• Clinical Psychologist in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.