Provider Demographics
NPI:1689871584
Name:GARDNER, RITA FRANDSEN (LCSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:FRANDSEN
Last Name:GARDNER
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 1:9130 FIRELIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-4125
Mailing Address - Country:US
Mailing Address - Phone:916-361-1602
Mailing Address - Fax:916-361-1662
Practice Address - Street 1:9130 FIRELIGHT WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4125
Practice Address - Country:US
Practice Address - Phone:916-361-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24795103TC0700X
CA17730 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17730 LCSWOtherBBS PROVIDER LICENSE #