Individual
KELLY GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
131 BOSTON POST RD, EAST LYME, CT 06333-1605
(860) 333-5183
Mailing address
131 BOSTON POST RD, EAST LYME, CT 06333-1605
(860) 333-5183
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2301
CT
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-26-87881
BCBA
CT
01
—
2301
LBA
CT
Enumeration date
12/23/2020
Last updated
03/11/2026
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