Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 10383 | CT |
NPI | 1225443856 |
---|---|
Provider Name | Mr. Kevin Lardner |
First Address | New Haven, CT 06511-5946 |
Second Address | Southington, CT 06489-0268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 22/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004041000 | (05) | CT |
004217099 | (05) | CT |
008003745 | (05) | CT |
008083698 | (05) | CT |