Provider Demographics
NPI:1508153073
Name:GARDNER, ELIZABETH A (LCMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:SAXTONS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05154-0277
Mailing Address - Country:US
Mailing Address - Phone:802-258-7766
Mailing Address - Fax:
Practice Address - Street 1:70 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6096
Practice Address - Country:US
Practice Address - Phone:802-258-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor