Provider Demographics
NPI:1467101279
Name:GALLO, JENNA M (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:GALLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:BODISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:260 WASHINGTON AVENUE EXT STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6326
Mailing Address - Country:US
Mailing Address - Phone:518-218-1188
Mailing Address - Fax:
Practice Address - Street 1:260 WASHINGTON AVENUE EXT STE 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6326
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104973104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker