Active NPI
Maria Willis Gordon, LISW, LICDC
- Social Worker
- Canton, OH
National Provider Identifier
1902829682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- I5078
- Practice address
- 1930 Fulton Rd NW
Suite 102
Canton, OH 44709-3526 - Phone
- (330) 430-9535
- Fax
- (330) 430-9534
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | I5078 | OH | Primary |
Addresses
Primary practice location
1930 Fulton Rd NW
Suite 102
Canton, OH 44709-3526
Mailing address
PO Box 9444
Canton, OH 44711-9444
Phone (330) 430-9535
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000388720 | Other | OH | ANTHEM BC/BS |
| 318639 | Other | OH | UNITED BEHAVORIAL HEALTH |
| 760801293027 | Other | OH | CARESOURCE |
| 80249800 | Other | OH | MEGELLAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I5078 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902829682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9444",
"city": "CANTON",
"state": "OH",
"postal_code": "447119444",
"telephone_number": "330-430-9535",
"fax_number": "330-430-9534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 FULTON RD NW",
"address_2": "SUITE 102",
"city": "CANTON",
"state": "OH",
"postal_code": "447093526",
"telephone_number": "330-430-9535",
"fax_number": "330-430-9534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MARIA",
"middle_name": "WILLIS",
"name_prefix": "Mrs.",
"credential": "LISW, LICDC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "I5078",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "00000388720",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVORIAL HEALTH",
"identifier": "318639",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "760801293027",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEGELLAN",
"identifier": "80249800",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.