Provider Demographics
NPI:1336578996
Name:GARDNER, KIRBY (LCMHC)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:
Other - Last Name:FOOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAGS
Mailing Address - Street 1:4 SWIFT LN
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4840
Mailing Address - Country:US
Mailing Address - Phone:603-714-1725
Mailing Address - Fax:
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:300
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2720
Practice Address - Country:US
Practice Address - Phone:951-547-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3088807Medicaid