Individual
ROBERT GORDON
Active
Individual
ROBERT GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS002355L
PA
103TB0200X
Cognitive & Behavioral Psychologist
PS002355L
PA
103TC0700X
Clinical Psychologist
Primary
PS002355L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01097501
CAPITAL BLUE CROSS
PA
01
—
119323
VALUE OPTIONS
PA
01
—
2176815
CIGNA BEHAVIORAL HEALTH
PA
01
—
279849000
MAGELLAN
PA
01
—
GO154450
PA BLUE SHIELD
PA
Enumeration date
06/15/2006
Last updated
06/13/2016
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