Provider Demographics
NPI:1497744346
Name:GALE, JOAN EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:EILEEN
Last Name:GALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 N 41ST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1128
Mailing Address - Country:US
Mailing Address - Phone:602-439-8677
Mailing Address - Fax:
Practice Address - Street 1:10640 N 28TH DR
Practice Address - Street 2:C205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4527
Practice Address - Country:US
Practice Address - Phone:602-439-8677
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 0301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35985Medicare UPIN
AZCSW 301IMedicare ID - Type Unspecified