Provider Information for 1912094582
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VILMA MARTINEZ GORDON LCSW
Sex: Female
NPI: 1912094582
Last Updated: 2009-04-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1912094582 | ||||||||
| Enumeration Date | 2006-10-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1241 LAFAYETTE AVE BRONX, NY 10474-5336 United States Phone: 718-378-6500 | Fax:718-993-0647 | ||||||||
| Primary Practice Address | 651 ACADEMY ST 2ND FLOOR NEW YORK, NY 10034-5003 United States Phone: 212-942-0043 | Fax: | ||||||||
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