Healthcare Provider Details

I. General information

NPI: 1831189703
Provider Name (Legal Business Name): SYDNEY H. GARDNER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ZELDA RD
MONTGOMERY AL
36106-2648
US

IV. Provider business mailing address

1338 MAGNOLIA CURV
MONTGOMERY AL
36106-2011
US

V. Phone/Fax

Practice location:
  • Phone: 334-262-7787
  • Fax: 334-262-7795
Mailing address:
  • Phone: 334-233-3080
  • Fax: 334-356-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1354
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: