Healthcare Provider Details

I. General information

NPI: 1225443856
Provider Name (Legal Business Name): KEVIN LARDNER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 MERIDEN WATERBURY TURNPIKE SUITE K 11
SOUTHINGTON CT
06489-0268
US

IV. Provider business mailing address

1 LONG WHARF DR STE 321
NEW HAVEN CT
06511-5946
US

V. Phone/Fax

Practice location:
  • Phone: 203-404-1010
  • Fax: 860-426-2898
Mailing address:
  • Phone: 203-781-4600
  • Fax: 203-781-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10383
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: