Provider Demographics
NPI:1073733077
Name:GARDNER, NANCY J (MSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PRINCETON AVENUE SUITE 2B
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525
Mailing Address - Country:US
Mailing Address - Phone:609-466-5757
Mailing Address - Fax:
Practice Address - Street 1:83 PRINCETON AVENUE SUITE 2B
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08525
Practice Address - Country:US
Practice Address - Phone:609-466-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 018321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640400Medicare PIN