Provider Demographics
NPI:1396880282
Name:GARDNER, JOHN L (LMFT MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:M
Credentials:LMFT MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062
Practice Address - Country:US
Practice Address - Phone:413-586-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist