Provider Demographics
NPI:1720219462
Name:GALLUZZO, MARYROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYROSE
Middle Name:
Last Name:GALLUZZO
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 1:1907 N LAMAR BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4992
Mailing Address - Country:US
Mailing Address - Phone:512-981-8281
Mailing Address - Fax:
Practice Address - Street 1:1907 N LAMAR BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4992
Practice Address - Country:US
Practice Address - Phone:512-981-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255551041C0700X
TX413761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical