Provider Demographics
NPI:1891328373
Name:KATE BRADLEY GARDNER, LCSW, LLC
Entity type:Organization
Organization Name:KATE BRADLEY GARDNER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-374-3119
Mailing Address - Street 1:7 OLD SHERMAN TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4174
Mailing Address - Country:US
Mailing Address - Phone:860-374-3119
Mailing Address - Fax:
Practice Address - Street 1:7 OLD SHERMAN TPKE STE 102
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4174
Practice Address - Country:US
Practice Address - Phone:860-374-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT282235Medicaid