Provider Demographics
NPI:1598050411
Name:GARDINER, SARAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GARDINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 PITTSFORD VICTOR RD
Mailing Address - Street 2:103
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3800
Mailing Address - Country:US
Mailing Address - Phone:585-953-8824
Mailing Address - Fax:
Practice Address - Street 1:1151 PITTSFORD VICTOR RD
Practice Address - Street 2:103
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3800
Practice Address - Country:US
Practice Address - Phone:585-953-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0813771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical