Provider Demographics
NPI:1942565767
Name:GITTENS-GALLOWAY, SIOMARA (CSW)
Entity Type:Individual
Prefix:
First Name:SIOMARA
Middle Name:
Last Name:GITTENS-GALLOWAY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD.
Mailing Address - Street 2:STE. N804
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3147
Mailing Address - Country:US
Mailing Address - Phone:504-349-6360
Mailing Address - Fax:504-349-6363
Practice Address - Street 1:1111 MEDICAL CENTER BLVD.
Practice Address - Street 2:STE. N804
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3147
Practice Address - Country:US
Practice Address - Phone:504-349-6360
Practice Address - Fax:504-349-6363
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7067OtherLICENSED MASTER SOCIAL WORKER