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Individual
MRS. MARIA WILLIS GORDON
Active
Individual
MRS. MARIA WILLIS GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW, LICDC
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I5078
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000388720
ANTHEM BC/BS
OH
01
—
318639
UNITED BEHAVORIAL HEALTH
OH
01
—
760801293027
CARESOURCE
OH
01
—
80249800
MEGELLAN
OH
Enumeration date
07/25/2006
Last updated
07/08/2007
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