Provider Demographics
NPI:1548769854
Name:GALLIGAN, MICHAEL R (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:GALLIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTRAL MAINE XING
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-6320
Mailing Address - Country:US
Mailing Address - Phone:207-582-6608
Mailing Address - Fax:207-582-2258
Practice Address - Street 1:5 CENTRAL MAINE XING
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-6320
Practice Address - Country:US
Practice Address - Phone:207-582-6608
Practice Address - Fax:207-582-2258
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162961041C0700X
MELC20106104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical