Provider Demographics
NPI:1538370333
Name:GORDON, JUDITH LYNNE (MS)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNNE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-1153
Mailing Address - Country:US
Mailing Address - Phone:717-692-3604
Mailing Address - Fax:717-238-7894
Practice Address - Street 1:1000 MEDICAL ROAD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061
Practice Address - Country:US
Practice Address - Phone:717-896-8940
Practice Address - Fax:717-695-5381
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health