Provider Demographics
NPI:1205192895
Name:HARDY-GARDNER, LISA ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:HARDY-GARDNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HARDY-GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 3644
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-0644
Mailing Address - Country:US
Mailing Address - Phone:203-439-5555
Mailing Address - Fax:
Practice Address - Street 1:116 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5204
Practice Address - Country:US
Practice Address - Phone:203-439-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00005104100000X, 251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health