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General NPI Number Information
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NPI Number | 1396857694
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Entity Type | Individual
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Provider Name | GEORGE L. GARDNER M.S.W. /L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4146 PARK BLVD
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City | OAKLAND
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State | CA
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Zip | 94602-1207
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Country | US
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Telephone | 510-482-1002
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Fax | 510-482-1000
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Provider Business Mailing Address
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Address Line | 4146 PARK BLVD
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City | OAKLAND
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State | CA
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Zip | 94602-1207
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Country | US
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Telephone | 510-482-1002
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Fax | 510-482-1000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 1342
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License Number State | CA
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