Lisa Beth Gordon, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Practice address

618 Library Place
Evanston, IL 60201-2908

Phone

(847) 733-4300

Fax

(847) 733-0390

NPI assigned

Feb 20, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Lisa Beth Myers Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1407024771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 LIBRARY PLACE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012908",
            "telephone_number": "847-733-4300",
            "fax_number": "847-733-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 LIBRARY PLACE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012908",
            "telephone_number": "847-733-4300",
            "fax_number": "847-733-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "LISA",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY6692",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "U26622",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MYERS",
            "middle_name": "BETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bonnie Lynn Goodman, LCSW
• Emily Goodman, CPNP
• Rebecca Joy Goodman
• Carin R Gordon, M.D.
• Carol Evelyn Gordon, LCSW
• Michael Edward Gordon, DDS
• Rana Gordon, PHD
• Robert A. Gordon, MD
• William Edward Gordon, D.D.S
• Margaret Dembo Gore, MD

• Clinical Psychologist in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.

Verify at the official NPI Registry.