NPIMap

Organization Active NPI

Ellen J Gordon Licensed Master Social Worker PC

  • Clinical Social Worker
  • Port Jefferson Station, NY
National Provider Identifier
1295367019
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
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
Last updated
Mar 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Ellen GordonNPI 1780238725
Title
LCSW
Phone
(631) 649-6278

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

8 Roosevelt Ave
Port Jefferson Station, NY 11776-3337

Mailing address

507 Empire Ave
West Babylon, NY 11704-3306
Phone (631) 649-6278

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • 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.