Healthcare Provider Details

I. General information

NPI: 1861498586
Provider Name (Legal Business Name): GISELA SARDINAS APRN, LCSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S ELM ST
WALLINGFORD CT
06492-4741
US

IV. Provider business mailing address

15 S ELM ST
WALLINGFORD CT
06492-4741
US

V. Phone/Fax

Practice location:
  • Phone: 203-606-2260
  • Fax: 203-235-2260
Mailing address:
  • Phone: 203-606-2260
  • Fax: 203-235-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003308
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000558
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004973
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number072669
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: