Provider Demographics
NPI:1740904879
Name:GARDNER, MIRIAM (LMFT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 CANTITOE ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-1107
Mailing Address - Country:US
Mailing Address - Phone:917-612-3099
Mailing Address - Fax:
Practice Address - Street 1:618 CANTITOE ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1107
Practice Address - Country:US
Practice Address - Phone:917-612-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001818103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily