Provider Demographics
NPI:1730518101
Name:GARDY, JOANNA L (LMHC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:GARDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 WASHINGTON ST STE 316
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2517
Mailing Address - Country:US
Mailing Address - Phone:617-851-0171
Mailing Address - Fax:
Practice Address - Street 1:4238 WASHINGTON ST STE 316
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2517
Practice Address - Country:US
Practice Address - Phone:617-851-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health