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General NPI Number Information
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NPI Number | 1942635727
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Entity Type | Individual
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Provider Name | BEN M GARDNER PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
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City | APO
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State | AE
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Zip | 09180
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Country | US
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Telephone | 314-636-9900
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 473 BOX 1010
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City | APO
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State | AE
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Zip | 09606-0011
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Country | US
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Telephone | 348-682-2637
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60894981
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License Number State | WA
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