Provider Demographics
NPI:1861498586
Name:SARDINAS, GISELA (APRN, LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:SARDINAS
Suffix:
Gender:F
Credentials:APRN, LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4741
Mailing Address - Country:US
Mailing Address - Phone:203-606-2260
Mailing Address - Fax:203-235-2260
Practice Address - Street 1:15 S ELM ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4741
Practice Address - Country:US
Practice Address - Phone:203-606-2260
Practice Address - Fax:203-235-2260
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000558101YA0400X
CT0049731041C0700X
CT072669163W00000X
CT003308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236338Medicaid
CT800003316Medicare ID - Type Unspecified
CT004236338Medicaid