Provider Demographics
NPI:1790171049
Name:SPAULDING, GARDA JEAN
Entity Type:Individual
Prefix:
First Name:GARDA
Middle Name:JEAN
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 63RD RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1160
Mailing Address - Country:US
Mailing Address - Phone:718-459-1225
Mailing Address - Fax:718-459-5805
Practice Address - Street 1:9520 63RD RD
Practice Address - Street 2:SUITE J
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1160
Practice Address - Country:US
Practice Address - Phone:718-459-1225
Practice Address - Fax:718-459-5805
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical