Provider Demographics
NPI:1023406030
Name:GORDON,, JOHN JOSEPH JR (CASAC, ICADC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:GORDON,
Suffix:JR
Gender:M
Credentials:CASAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 VIRGINIA AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5764
Mailing Address - Country:US
Mailing Address - Phone:917-309-2067
Mailing Address - Fax:
Practice Address - Street 1:68 VIRGINIA AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5764
Practice Address - Country:US
Practice Address - Phone:917-309-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)