Provider Demographics
NPI:1295021509
Name:KILGALLON, DAVID (LICSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KILGALLON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ROUTE 134
Mailing Address - Street 2:STE 10
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-3740
Mailing Address - Country:US
Mailing Address - Phone:508-394-0959
Mailing Address - Fax:508-394-0979
Practice Address - Street 1:23 ROUTE 134
Practice Address - Street 2:STE 10
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3740
Practice Address - Country:US
Practice Address - Phone:508-394-0959
Practice Address - Fax:508-394-0959
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1174811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical