Shirlene Mineta Gordon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

002518 Issued in GA

Practice address

1264 Emma Jean PL SW
Marietta, GA 30064-3798

Phone

(770) 912-8894

Fax

(770) 573-7316

NPI assigned

Aug 21, 2008

Sex

Female

Sole proprietor

No

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 GA

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

State licenses

Practice roles

Locations

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.

• Tailoriste Consultants, Inc.

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1427911353
  NPD Authorized official

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1982851820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 DALLAS HWY SW STE 202",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300647505",
            "telephone_number": "770-912-8894",
            "fax_number": "770-573-7316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 EMMA JEAN PL SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300643798",
            "telephone_number": "770-912-8894",
            "fax_number": "770-573-7316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SHIRLENE",
        "middle_name": "MINETA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-21",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "002518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Gopin, MA, APC
• Amanda Gordon, RBT, BS
• Brian M Gordon, MD
• Haley Gordon
• Lewis Gordon
• Vershawn Gordon, RBT
• Larona Gore, B.S., D.C.
• Dawn Niki Gori, MA, BC-TMH, NCC, LPC
• Trey Gorman
• Holly E Gossett, PA-C

• Clinical Social Worker in Marietta, GA
• Providers in Marietta, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; 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.