MEDICARE: KAREN GARDNER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003319	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D6513	OTHER	NC	MEDCOST
2	1205W	OTHER	NC	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275511792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN GARDNER LCSW

Provider Business Mailing Address
First Line	:	2516 INDEPENDENCE BLVD
Second Line	:	SUITE 204
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2437
Country	:	US
Telephone Number	:	910-796-9969
Fax Number	:	910-796-0270

Provider Business Practice Location Address
First Line	:	2516 INDEPENDENCE BLVD
Second Line	:	SUITE 204
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2437
Country	:	US
Telephone Number	:	910-796-9969
Fax Number	:	910-796-0270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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