Provider Demographics
NPI:1942612791
Name:MICHAEL GALLAGHER
Entity Type:Organization
Organization Name:MICHAEL GALLAGHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-389-9450
Mailing Address - Street 1:422 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5122
Mailing Address - Country:US
Mailing Address - Phone:561-389-9450
Mailing Address - Fax:954-366-3075
Practice Address - Street 1:422 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5122
Practice Address - Country:US
Practice Address - Phone:561-389-9450
Practice Address - Fax:954-366-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBZ595AOtherPTAN
FLZ01UDOtherBCBS
FL674627OtherVALUE OPTIONS