Provider Demographics
NPI:1295756914
Name:GALLANT, JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GALLANT
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 1:48 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-3229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1437
Practice Address - Country:US
Practice Address - Phone:207-620-8495
Practice Address - Fax:207-620-8498
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC60651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical