Active NPI
Terie Lynn Gardner, LCSW
- Clinical Social Worker
- Fairfield, CA
National Provider Identifier
1528120276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 21319
- Practice address
- 1745 Enterprise Dr
Fairfield, CA 94533-5801 - Phone
- (707) 399-4900
- NPI assigned
- Dec 15, 2006
- Last updated
- Mar 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | 21319 | CA | Primary |
Addresses
Primary practice location
1745 Enterprise Dr
Fairfield, CA 94533-5801
Mailing address
2101 Courage Dr
Fairfield, CA 94533-6717
Phone (707) 784-2133
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21319 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299715200000",
"number": "1528120276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 COURAGE DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336717",
"telephone_number": "707-784-2133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 ENTERPRISE DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335801",
"telephone_number": "707-399-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "TERIE",
"middle_name": "LYNN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-15",
"last_updated": "2011-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "21319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.