Julie A Gordon-Dueck, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PS007868L Issued in PA

Practice address

964 Isabel Dr
Lebanon, PA 17042-7482

Phone

(717) 274-9777

Fax

(717) 274-9815

NPI assigned

Jun 8, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

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, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

PhilhavenGroup PAC ID 8729991419, 93 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Philhaven

  • Psychiatry Physician
  • Lebanon, PA
  • NPI 1043316441

  PA

  Medicare reassignment Care Compare group
• Philhaven

  • Psychiatric Hospital
  • Lebanon, PA
  • NPI 1972598076
  Care Compare group
• Philhaven

  • Clinic/Center
  • Lebanon, PA
  • NPI 1275758393
  NPD
• Philhaven

  • Clinic/Center
  • Lebanon, PA
  • NPI 1508081639
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1053514737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 ISABEL DR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427482",
            "telephone_number": "717-274-9777",
            "fax_number": "717-274-9815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON-DUECK",
        "first_name": "JULIE",
        "middle_name": "A",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS007868L",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS007868L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103352242",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PS007868L",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11824245",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Good Samaritian Physician Services
• Good Samaritian Physician Services
• Mary Elizabeth Good, O.D.
• Tiffany Good
• Sandy Goodstein, PA/C
• Kevin Gordon, PA-C
• Katie I Gorey, LCSW
• Apryl Gorton
• Bryan Gottlieb, PSY.D.
• Dominic Gould, MA, LPC

• All providers in Lebanon, PA
• Clinical Child & Adolescent Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.