Healthcare Provider Details

I. General information

NPI: 1235634056
Provider Name (Legal Business Name): RACHEL MARIA GARDNER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 COLLEGE AVE # 5
SANTA ROSA CA
95404-4108
US

IV. Provider business mailing address

PO BOX 2944
SANTA ROSA CA
95405-0944
US

V. Phone/Fax

Practice location:
  • Phone: 707-806-8731
  • Fax:
Mailing address:
  • Phone: 707-806-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: