Active NPI
Jacquelyn Gordon
- Marriage & Family Therapist
- Pasadena, CA
National Provider Identifier
1033872692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT149970
- Practice address
- 1055 E Colorado Blvd Ste 560
Pasadena, CA 91106-2380 - Phone
- (818) 241-6780
- Fax
- (818) 241-6853
- NPI assigned
- Oct 20, 2021
- Reactivated
- Dec 9, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | AMFT149970 | CA | Primary |
Addresses
Primary practice location
1055 E Colorado Blvd Ste 560
Pasadena, CA 91106-2380
Mailing address
1055 E Colorado Blvd Ste 560
Pasadena, CA 91106-2380
Phone (818) 241-6780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMFT149970 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salt Marriage and Family Therapy | Marriage & Family Therapist | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Marriage & Family Therapist
- Long Beach, CA
- NPI 1306660774
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733875200000",
"number": "1033872692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 E COLORADO BLVD STE 560",
"city": "PASADENA",
"state": "CA",
"postal_code": "911062380",
"telephone_number": "818-241-6780",
"fax_number": "818-241-6853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 E COLORADO BLVD STE 560",
"city": "PASADENA",
"state": "CA",
"postal_code": "911062380",
"telephone_number": "818-241-6780",
"fax_number": "818-241-6853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "JACQUELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-20",
"last_updated": "2024-12-11",
"certification_date": "2024-12-11",
"deactivation_date": "2024-11-12",
"reactivation_date": "2024-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "AMFT149970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.