Basic Information
| Provider Information | |||||||||
| NPI: | 1609029628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | CRETE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A.-C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 ROUTE 37 W UNIT 105-9 | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087572377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322860341 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1945 CORLIES AVE | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327762325 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2008 | ||||||||
| LastUpdateDate: | 11/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SW01122400 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.