Provider Demographics
NPI:1518580695
Name:GARDNER, ROBIN SHAWN (CDC, CPC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:SHAWN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CDC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E RIDGEWOOD AVE # 245
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3880
Mailing Address - Country:US
Mailing Address - Phone:201-612-6700
Mailing Address - Fax:
Practice Address - Street 1:27 CHESTNUT ST STE 1B
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3845
Practice Address - Country:US
Practice Address - Phone:201-612-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCERTIFICATION101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional