Individual
ANGELA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
56 BAY ST FL 6, STATEN ISLAND, NY 10301-2563
(718) 808-1428
Mailing address
56 BAY ST FL 6, STATEN ISLAND, NY 10301-2563
(718) 808-1428
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21007
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02521240
—
NY
Enumeration date
11/04/2015
Last updated
11/04/2015
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