Provider Demographics
NPI:1710236070
Name:GALLAGHER, KATHLEEN D (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 OAK RD
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3402
Mailing Address - Country:US
Mailing Address - Phone:410-903-9053
Mailing Address - Fax:
Practice Address - Street 1:7007 BRADLEY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2149
Practice Address - Country:US
Practice Address - Phone:301-767-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD067671041C0700X
VA09040076531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical