Individual
AVIGAIL GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
34 W 139TH ST, NEW YORK, NY 10037-1508
(718) 208-5367
Mailing address
6940 108TH ST APT 6E, FOREST HILLS, NY 11375-3823
(718) 544-0196
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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