Provider Demographics
NPI:1811326358
Name:GORDON, DENISE (PSYD, MFT)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 N. LINDEN DRIVE
Mailing Address - Street 2:SUITE 246
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2203
Mailing Address - Country:US
Mailing Address - Phone:310-858-8661
Mailing Address - Fax:
Practice Address - Street 1:462 N. LINDEN DRIVE
Practice Address - Street 2:SUITE 246
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2203
Practice Address - Country:US
Practice Address - Phone:310-858-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist