Provider Demographics
NPI:1174741771
Name:GORDON, DAHLIA V (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAHLIA
Middle Name:V
Last Name:GORDON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3506
Mailing Address - Country:US
Mailing Address - Phone:954-430-2247
Mailing Address - Fax:954-788-8854
Practice Address - Street 1:1000 W MCNAB RD
Practice Address - Street 2:SUITE 231
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4719
Practice Address - Country:US
Practice Address - Phone:954-788-8853
Practice Address - Fax:954-788-8854
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6827103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical