Individual
MR. CHAD VAN GORDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
5 VANDERBERG DR, FAIRPORT, NY 14450-8427
(315) 783-7893
Mailing address
5 VANDERBERG DR, FAIRPORT, NY 14450-8427
(315) 783-7893
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
106332-01
NY
Other
Enumeration date
03/02/2023
Last updated
03/02/2023
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