Provider Demographics
NPI:1194202960
Name:GARDNER, KARIN (MSW, LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FLENSBURG DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9731
Mailing Address - Country:US
Mailing Address - Phone:518-269-2179
Mailing Address - Fax:
Practice Address - Street 1:32 FLENSBURG DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-9731
Practice Address - Country:US
Practice Address - Phone:518-269-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01345191041C0700X
NY093358-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical