Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 018807 | NY |
NPI | 1063713022 |
---|---|
Provider Name | Dr. Karen Gordon |
First Address | Queens Village, NY 11427-1831 |
Second Address | Queens Village, NY 11427-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2010 |
Last Update Date | 23/08/2021 |