Provider Demographics
NPI:1306808985
Name:GARDNER, MARY LAMBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LAMBERT
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9 TULIP POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3376
Mailing Address - Country:US
Mailing Address - Phone:410-608-1464
Mailing Address - Fax:
Practice Address - Street 1:9 TULIP POPLAR CT
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3376
Practice Address - Country:US
Practice Address - Phone:410-608-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical