Provider Demographics
NPI:1801420724
Name:GARDNER, TERA FELDT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TERA
Middle Name:FELDT
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 31403 BOX 13
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-1403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VIA GIORGIO CORBETTA, 17
Practice Address - Street 2:
Practice Address - City:VICENZA
Practice Address - State:VI
Practice Address - Zip Code:36100
Practice Address - Country:IT
Practice Address - Phone:314-636-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC41161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical