# MARA GORDON LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184061038
- **Authorized official:** MS. MARA JOAN GORDON P.T. (SOLE PROPRIETOR)
- **Authorized official phone:** (917) 514-9831

## Contact information

- **Practice address:** 221 NICHOLS ST, CARMEL, NY 10512-5022
- **Practice address phone:** (917) 514-9831
- **Practice address fax:** (845) 225-4034
- **Mailing address:** 221 NICHOLS ST, CARMEL, NY 10512-5022
- **Mailing address phone:** (917) 514-9831
- **Mailing address fax:** (845) 225-4034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 012715 | NY | Yes |

## Other

- **Enumeration date:** 06/02/2013
- **Last updated:** 06/02/2013