MEDICARE: CHARLENE GARDNER MSW

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

General Provider Information

NPI Number	:	1821406448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE GARDNER MSW

Provider Business Mailing Address
First Line	:	3677 CENTRAL AVE
Second Line	:	STE I
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8226
Country	:	US
Telephone Number	:	239-839-3907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3677 CENTRAL AVE
Second Line	:	STE I
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8226
Country	:	US
Telephone Number	:	239-839-3907
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	02/10/2019

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