Provider Demographics
NPI:1215159496
Name:GARDNER, NANCY NOBLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:NOBLE
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 1:4 NORMANSKILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1335
Mailing Address - Country:US
Mailing Address - Phone:518-465-9700
Mailing Address - Fax:
Practice Address - Street 1:4 NORMANSKILL BLVD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1335
Practice Address - Country:US
Practice Address - Phone:518-465-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0206651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical