Holly Lee Gordon, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

079684-1 Issued in NY

Practice address

468 Main St
Mastic Beach, NY 11951-3407

Phone

(631) 294-0216

Fax

(631) 772-6221

NPI assigned

Aug 18, 2009

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

• Holly Gordon Professional name

Medicare fee-for-service enrollment

Enrolled in NY

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Community Counseling and LCSW ServicesGroup PAC ID 3577605617, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Community Counseling Too LCSW Services PLLC

  • Clinical Social Worker
  • Mastic Beach, NY
  • NPI 1619707650
  Medicare reassignment NPD Authorized official
• Community Counseling & LCSW Services PC

  dba Community Counseling & LCSW Services

  • Clinical Social Worker
  • Center Moriches, NY
  • NPI 1770819690
  Medicare reassignment Care Compare group
• Counseling Connections Community Center Inc

  • Clinical Social Worker
  • Mastic Beach, NY
  • NPI 1851116321
  Medicare reassignment NPD
• Qureshi Medical Services PLLC

  dba Qureshi Medical Services

  • Psychiatry Physician
  • Center Moriches, NY
  • NPI 1316763162
  NPD (past)

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1215169602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ALCOLADE DR E",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119673839",
            "telephone_number": "631-294-0216",
            "fax_number": "631-722-6221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "468 MAIN ST",
            "city": "MASTIC BEACH",
            "state": "NY",
            "postal_code": "119513407",
            "telephone_number": "631-294-0216",
            "fax_number": "631-772-6221"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 Main St South",
            "address_purpose": "LOCATION",
            "city": "Center Moriches",
            "state": "NY",
            "postal_code": "11934",
            "country_code": "US",
            "telephone_number": "631-772-6220",
            "fax_number": "631-772-6221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "HOLLY",
        "middle_name": "LEE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-18",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "079684-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "GORDON",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Social Worker in Mastic Beach, NY
• Providers in Mastic Beach, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.