Provider Demographics
NPI:1568470573
Name:GALLAGHER, MARIA MORMAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:MORMAY
Last Name:GALLAGHER
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 1:1075 EAST LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06370
Mailing Address - Country:US
Mailing Address - Phone:860-917-1779
Mailing Address - Fax:
Practice Address - Street 1:1 WAHOO DRIVE
Practice Address - Street 2:449
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5600
Practice Address - Country:US
Practice Address - Phone:860-694-4966
Practice Address - Fax:860-694-3388
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT88231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical