Ellen J Gordon Licensed Master Social Worker PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ELLEN J GORDON LICENSED MASTER SOCIAL WORKER PC

Practice address

8 Roosevelt Ave
Port Jefferson Station, NY 11776-3337

Phone

(631) 736-7707

NPI assigned

Feb 10, 2020

Organization subpart

No

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

Authorized official

Name

Ellen Gordon

Title

LCSW

Phone

(631) 649-6278

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1295367019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 EMPIRE AVE",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117043306",
            "telephone_number": "631-649-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763337",
            "telephone_number": "631-736-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN J GORDON LICENSED MASTER SOCIAL WORKER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-10",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "631-649-6278"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward J Moylan OD PC
• Laura Edwards
• Sheri Renee Anna Egert, OTR/L
• Luis J Ehrman Sr., ANP-C
• Maria Eliades, DMD
• Donna Rosemarie Ellis-Brea, RN
• Mary Emerson, RN
• Osamokpuwa Erhabor
• Thomas P. Erhart, D.O.
• Ernest Leuci LCSW PC

• Clinical Social Worker in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.