Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 500149 | MA |
NPI | 1073022646 |
---|---|
Provider Name | Ms. Laura J Gordon |
First Address | Rockaway Park, NY 11694-2036 |
Second Address | Brooklyn, NY 11201-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 11/02/2021 |