Provider Demographics
NPI:1194149377
Name:GARDNER, JENNIFER MURIEL
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MURIEL
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 DAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1722
Mailing Address - Country:US
Mailing Address - Phone:860-731-5522
Mailing Address - Fax:860-731-5536
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:SUITE 270
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5760
Practice Address - Country:US
Practice Address - Phone:860-885-6054
Practice Address - Fax:860-253-5036
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical