Kerensa Daniela Gordon, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

091284 Issued in NY

Practice address

858 E 29TH St
Brooklyn, NY 11210-2927

Phone

(718) 859-4500

NPI assigned

Jul 15, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kerensa Daniela Gulliver Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Impactful Counseling and Consulting

  • Clinical Social Worker
  • New York, NY
  • NPI 1023633641
  NPD (past)

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1750722062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 NEW YORK AVE",
            "address_2": "APT 1A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112101762",
            "telephone_number": "718-287-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "858 E 29TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112102927",
            "telephone_number": "718-859-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KERENSA",
        "middle_name": "DANIELA",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-15",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NY",
            "license": "443701101",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "091284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERENSA",
            "last_name": "GULLIVER",
            "middle_name": "DANIELA",
            "credential": "BACK",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Imani Tikeyah Gordon, OTR
• Inna Gordon, R.N.
• Judith Gordon, RN
• Kamala Gordon, M.D.
• Kathy Gordon, CSW, DSW
• Kimberley Gordon
• Laura J Gordon, PSYD, MA.CAGS
• Letitia Eunice Gordon, LCSW
• Lorna Gordon, RN
• Lucy Hope Elenko Gordon, LMSW

• Social Worker in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.