Individual
DERRICK M GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
389 WHITNEY AVE, NEW HAVEN, CT 06511-2301
(203) 789-7645
(203) 562-6355
Mailing address
44 OLD QUARRY RD, WOODBRIDGE, CT 06525-1006
(203) 675-4228
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
003297
CT
Other
Enumeration date
10/16/2017
Last updated
10/16/2017
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