Provider Demographics
NPI:1346345964
Name:GARDENSWARTZ, CARA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:A
Last Name:GARDENSWARTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S WOODBURN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3028
Mailing Address - Country:US
Mailing Address - Phone:310-893-0096
Mailing Address - Fax:
Practice Address - Street 1:21 DOWNING ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4704
Practice Address - Country:US
Practice Address - Phone:310-893-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18399Medicare ID - Type UnspecifiedPSYCHOLOGIST