Provider Demographics
NPI:1083158224
Name:GALLEGOS, SONIA (MSW)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BAILEY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3105
Mailing Address - Country:US
Mailing Address - Phone:760-326-9313
Mailing Address - Fax:760-326-2864
Practice Address - Street 1:1600 BAILEY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3105
Practice Address - Country:US
Practice Address - Phone:760-326-9313
Practice Address - Fax:760-326-2864
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW315541041C0700X, 101YM0800X
CA760671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health