Provider Demographics
NPI:1861563314
Name:GARDNER, JUDY K (LMFT)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:K
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2246
Mailing Address - Country:US
Mailing Address - Phone:860-236-6549
Mailing Address - Fax:
Practice Address - Street 1:1500 MAIN ST
Practice Address - Street 2:SAND CORPORATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2713
Practice Address - Country:US
Practice Address - Phone:860-278-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist