Individual
BEV GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
949 BRIDGEPORT AVE, MILFORD, CT 06460-3142
(203) 878-6365
Mailing address
130 WESTWOOD RD, FAIRFIELD, CT 06825-1615
(203) 333-6986
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006443
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77ABH0005CT01
ANTHEM PROVIDER NUMBER
CT
Enumeration date
04/12/2007
Last updated
07/08/2007
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