Healthcare Provider Details

I. General information

NPI: 1912295932
Provider Name (Legal Business Name): LAURA ELIZABETH GARDNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 VALLEY RD
NEW CANAAN CT
06840-3812
US

IV. Provider business mailing address

208 VALLEY RD
NEW CANAAN CT
06840-3812
US

V. Phone/Fax

Practice location:
  • Phone: 203-801-2313
  • Fax: 203-567-8587
Mailing address:
  • Phone: 203-801-2313
  • Fax: 203-567-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number277195-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1.082899
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: