Individual
DR. BARRY HALE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3601 GREEN RD, SUITE 200, BEACHWOOD, OH 44122-5725
(440) 886-9655
Mailing address
3601 GREEN RD, SUITE 200, BEACHWOOD, OH 44122-5725
(440) 886-9655
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2806
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000136466
ANTHEM
OH
01
—
265233
VALUEOPTIONS
OH
01
—
4092054
AETNA
OH
Enumeration date
03/21/2006
Last updated
07/08/2007
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