Provider Demographics
NPI:1174289912
Name:GORDON JAMES, TRACITY (LSW)
Entity type:Individual
Prefix:
First Name:TRACITY
Middle Name:
Last Name:GORDON JAMES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1723
Mailing Address - Country:US
Mailing Address - Phone:973-563-5446
Mailing Address - Fax:
Practice Address - Street 1:190 ROUTE 18 STE 304
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1407
Practice Address - Country:US
Practice Address - Phone:732-354-0623
Practice Address - Fax:732-354-0358
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06738800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker