Provider Demographics
NPI:1275106478
Name:GALLOWAY, MARCUS (LMSW)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STERLING PL APT 1G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4979
Mailing Address - Country:US
Mailing Address - Phone:313-576-6200
Mailing Address - Fax:
Practice Address - Street 1:500 STERLING PL APT 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4979
Practice Address - Country:US
Practice Address - Phone:313-576-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker