Provider Demographics
NPI:1275696106
Name:JOHNSON-GALLAGHER, NANCY E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:JOHNSON-GALLAGHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-6622
Mailing Address - Country:US
Mailing Address - Phone:401-667-7109
Mailing Address - Fax:401-667-7129
Practice Address - Street 1:1294 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-6622
Practice Address - Country:US
Practice Address - Phone:401-667-7109
Practice Address - Fax:401-667-7129
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW012301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINJ42859Medicaid
RI809022099Medicare ID - Type Unspecified
RINJ42859Medicaid