Provider Demographics
NPI:1700174067
Name:GORDON, JESSICA SARA (PSYD, BCBA)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SARA
Last Name:GORDON
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LONG DR
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1713
Mailing Address - Country:US
Mailing Address - Phone:516-314-1432
Mailing Address - Fax:
Practice Address - Street 1:155 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-2133
Practice Address - Country:US
Practice Address - Phone:516-314-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00534500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist