Provider Demographics
NPI:1851593388
Name:GALLAGHER, RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
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 1:64 WESTMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1961
Mailing Address - Country:US
Mailing Address - Phone:607-245-6994
Mailing Address - Fax:
Practice Address - Street 1:64 WESTMONT AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1961
Practice Address - Country:US
Practice Address - Phone:607-245-6994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00073399104100000X
NY0770151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker