| Charles H. Gardner, Pllc | |
|
139 State St Ste 2 Bangor ME 04401-5317 | |
| (207) 944-2069 | |
| Not Available |
| Full Name | Charles H. Gardner, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 139 State St Ste 2, Bangor, Maine |
| Authorized Official Name and Position | Charles Gardner (OWNER/LCSW) |
| Authorized Official Contact | 2076314415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles H. Gardner, Pllc 109 Mann Hill Rd Holden ME 04429-6228 Ph: () - | Charles H. Gardner, Pllc 139 State St Ste 2 Bangor ME 04401-5317 Ph: (207) 944-2069 |
| NPI Number | 1518628916 |
|---|---|
| Provider Enumeration Date | 01/07/2022 |
| Last Update Date | 01/07/2022 |
| Certification Date | 01/07/2022 |
| Medicare PECOS PAC ID | 6002208352 |
|---|---|
| Medicare Enrollment ID | O20220118000971 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518628916 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Charles Harold Gardner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790102093 PECOS PAC ID: 1951672955 Enrollment ID: I20170809003798 |
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