Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 022851-1 | NY |
N | 103T00000X | Psychologist | 022851-1 | NY |
Y | 103TH0100X | Health Service | 56332 | |
N | 103TS0200X | School Psychologist |
NPI | 1386044923 |
---|---|
Provider Name | Rachel Anne Gardner |
First Address | North Hornell, NY 14843-1107 |
Second Address | Bath, NY 14810-1580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2014 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05683858 | (05) | NY |