Individual
SAMUEL ANTONIO GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
102 IRVING ST NW, WASHINGTON, DC 20010-2921
(202) 877-1000
(202) 291-5366
Mailing address
102 IRVING ST NW, WASHINGTON, DC 20010-2921
(202) 877-1000
(202) 291-5366
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 1528
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103645
KAISER
—
01
—
247626
MAMSI
—
01
—
512762
NCPPO
—
01
—
5681292
AETNA NON HMO
—
01
—
DC 2528584
AETNA HMO
—
01
—
H360-0004
BS NCA
—
01
—
SMD 3839272
AETNA HMO
—
Enumeration date
08/09/2006
Last updated
12/11/2007
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