Elsie M. Gordon, PH.D., LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

04451 Issued in MD

Legal business name

ELSIE M. GORDON, PH.D., LLC

Practice address

13-15 E Deer Park Dr Ste 103D
Gaithersburg, MD 20877-2070

Phone

(240) 750-8847

NPI assigned

Mar 5, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Elsie Managbanag Gordon, PH.D.NPI 1003875246

Title

Psychologist

Phone

(240) 750-8847

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elsie Managbanag Gordon, PH.D.

  • Clinical Psychologist
  • Gaithersburg, MD
  • NPI 1003875246

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1619360385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13-15 E DEER PARK DR STE 103D",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772070",
            "telephone_number": "240-750-8847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13-15 E DEER PARK DR STE 103D",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772070",
            "telephone_number": "240-750-8847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELSIE M. GORDON, PH.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-05",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ELSIE",
        "authorized_official_middle_name": "MANAGBANAG",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "240-750-8847",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MD",
            "license": "04451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.