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NPI Code Detail

MEDICARE: AMY GARDINER LCSW

MEDICARE: AMY GARDINER 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
11041C0700XClinical Social WorkerSW9115FL

General Provider Information

NPI Number : 1659508919
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY GARDINER LCSW
Provider Business Mailing Address
First Line : 1830 NW 1ST WAY
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-5011
Country : US
Telephone Number : 631-553-2940
Fax Number :
Provider Business Practice Location Address
First Line : 901 S 62ND AVE
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33023-1848
Country : US
Telephone Number : 954-893-0109
Fax Number : 954-893-9750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2009
Last Update Date : 06/15/2009

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