Kaitlyn Nicole Gordon, LCSW-C

Primary specialty

Social WorkerTaxonomy code 104100000X

License

25407 Issued in MD

Practice address

626 Revolution St
Havre de Grace, MD 21078-3320

Phone

(410) 939-8744

NPI assigned

Sep 10, 2019

Last updated

Feb 2, 2023By the provider in NPPES

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

Other names 1

• Ms. Kaitlyn Nicole Latham Former name

Medicare fee-for-service enrollment

Enrolled in MD

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 Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Thrive Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Rosedale, MD
  • NPI 1053733378
  Medicare reassignment

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1114576329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783320",
            "telephone_number": "443-945-5420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783320",
            "telephone_number": "410-939-8744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KAITLYN",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "25407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "LATHAM",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "credential": "LCSW-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mercia Gee, LMSW
• Candice Giordano, MD
• Goetz Anesthesia Services, Inc.
• Gomez Yim & Rastogi, M.D., P.a. (Havre de Grace Pediatric Center)
• Anthony Franco Gonzales
• Ernest Glenn Gorleski, NFP-BC
• Kathleen M Gotzmann, M.D.
• Grace Home Medical Equipment LLC
• Amanda Graziano, MA
• Rachel Grden, LGSW

• Social Worker in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.