Provider Demographics
NPI:1255510574
Name:GALLAGHER, CATHLEEN SYBIL (RN LISW)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:SYBIL
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:RN LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORDOVA PL
Mailing Address - Street 2:#823
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1725
Mailing Address - Country:US
Mailing Address - Phone:505-906-8751
Mailing Address - Fax:
Practice Address - Street 1:1405 VEGAS VERDES
Practice Address - Street 2:#B238
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3009
Practice Address - Country:US
Practice Address - Phone:505-906-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-072071041C0700X
NMR48062163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health