Healthcare Provider Details

I. General information

NPI: 1497283972
Provider Name (Legal Business Name): JEFFREY PATRICK GARDNER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LINCOLN ST STE 201
WORCESTER MA
01605-3646
US

IV. Provider business mailing address

56 LONDONDERRY RD
GRAFTON MA
01519-1501
US

V. Phone/Fax

Practice location:
  • Phone: 508-308-1132
  • Fax:
Mailing address:
  • Phone: 508-308-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: