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NPI Code Detail

MEDICARE: MR. DOUGLAS EDWARD GARDNER LMSW

MEDICARE: MR. DOUGLAS EDWARD GARDNER LMSW
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
11041C0700XClinical Social Worker3222063501UT
21041C0700XClinical Social WorkerI1500231OH
31041C0700XClinical Social Worker1999CAL
41041C0700XClinical Social WorkerC6753MS
51041C0700XClinical Social Worker6801091525MI

General Provider Information

NPI Number : 1548200462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS EDWARD GARDNER LMSW
Provider Business Mailing Address
First Line : 37634 ENTERPRISE CT
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48331-3440
Country : US
Telephone Number : 248-553-0902
Fax Number : 248-553-2632
Provider Business Practice Location Address
First Line : 37634 ENTERPRISE CT
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48331-3440
Country : US
Telephone Number : 248-553-0902
Fax Number : 248-553-2632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 11/16/2021

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