Active NPI
Gail Mary Bourdon, LCSW, PH.D
- Clinical Social Worker
- Hartford, CT
National Provider Identifier
1346358181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 003561
- Practice address
- 200 Retreat Avenue
Hartford Hospital Psychiatry Department
Hartford, CT 06106-3310 - Phone
- (860) 545-7061
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 003561 | CT | Primary |
Addresses
Primary practice location
200 Retreat Avenue
Hartford Hospital Psychiatry Department
Hartford, CT 06106-3310
Mailing address
PO Box 40,000 Dept 634
Hartford Hospital Professional Services
Hartford, CT 06151-0634
Phone (860) 545-7602
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003561 | CT | MD | Clinical Psychologist |
| 3561 | CT | MD | Marriage & Family Therapist |
Interoperability endpoints
- gail.bourdon@xdr.hhchealthdirect.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256774400000",
"number": "1346358181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40,000 DEPT 634",
"address_2": "HARTFORD HOSPITAL PROFESSIONAL SERVICES",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061510634",
"telephone_number": "860-545-7602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 RETREAT AVENUE",
"address_2": "HARTFORD HOSPITAL PSYCHIATRY DEPARTMENT",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061063310",
"telephone_number": "860-545-7061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURDON",
"first_name": "GAIL",
"middle_name": "MARY",
"credential": "LCSW, PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2009-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "003561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.