Active NPI
Daniel M Gordon, PHD
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1376706622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS 006922 L
- Practice address
- 1518 Walnut St Ste 1202
Philadelphia, PA 19102-3407 - Phone
- (215) 735-3540
- NPI assigned
- Jul 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS 006922 L | PA | Primary |
Addresses
Primary practice location
1518 Walnut St Ste 1202
Philadelphia, PA 19102-3407
Mailing address
1518 Walnut St Ste 1202
Philadelphia, PA 19102-3407
Phone (215) 735-3540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS 006922 L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215475200000",
"number": "1376706622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1518 WALNUT ST STE 1202",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191023407",
"telephone_number": "215-735-3540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1518 WALNUT ST STE 1202",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191023407",
"telephone_number": "215-735-3540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "DANIEL",
"middle_name": "M",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-08",
"last_updated": "2008-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS 006922 L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.