Provider Demographics
NPI:1053372490
Name:GARDNER, JOSEPH (LMHC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:JOSEPH
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC LADAC I
Mailing Address - Street 1:18 POWDER HOUSE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492
Mailing Address - Country:US
Mailing Address - Phone:781-449-1447
Mailing Address - Fax:
Practice Address - Street 1:2020 CENTRE STREET
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:617-325-6700
Practice Address - Fax:617-325-6581
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3990OtherLMHC DIV OF PROF LICENSE
MA1910OtherLADCI DEPT OF PUB HEALTH