Individual
MS. BETH J GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
127 W STATE ST FL 1, ITHACA, NY 14850
(607) 273-7494
Mailing address
127 W STATE ST FL 1, ITHACA, NY 14850-5474
(607) 273-7494
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
020048
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020048
NEW YORK LICENSE
NY
Enumeration date
08/13/2008
Last updated
04/15/2019
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