Provider Demographics
NPI:1982849816
Name:GARDNER, DEBORAH DIANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DIANNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:DEBBIE
Other - Middle Name:DIANNE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-451-2186
Mailing Address - Fax:512-451-1950
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE E-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-451-2186
Practice Address - Fax:512-451-1950
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41236104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker