Provider Demographics
NPI:1346416435
Name:GARDNER-FLORES, ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GARDNER-FLORES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:395 PEQUOT AVE
Mailing Address - Street 2:APT.. 5
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1007 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-0839
Practice Address - Country:US
Practice Address - Phone:860-774-2020
Practice Address - Fax:860-779-5437
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074851041C0700X
CT001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid