Derrick M Gordon, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

003297 Issued in CT

Practice address

389 Whitney Ave
New Haven, CT 06511-2301

Phone

(203) 789-7645

Fax

(203) 562-6355

NPI assigned

Oct 16, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508112000000",
    "number": "1730690835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 OLD QUARRY RD",
            "city": "WOODBRIDGE",
            "state": "CT",
            "postal_code": "065251006",
            "telephone_number": "203-675-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 WHITNEY AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065112301",
            "telephone_number": "203-789-7645",
            "fax_number": "203-562-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "DERRICK",
        "middle_name": "M",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-16",
        "last_updated": "2017-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "003297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ulysses King Gomez Gopez, MD
• Kelly Gordie, AUD
• Michelle Gordon-Canning, P.A.
• Benjamin Gordon
• David Gordon, MD
• Emily Louise Gordon, MD
• Griffin T Gordon, LMFT-A
• Jesse Gordon, LADC, LCSW
• Matthew Ainey Gordon, PA-C
• Gerald A Gorecki, DPM

• Clinical Psychologist in New Haven, CT
• Providers in New Haven, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.