Provider Demographics
NPI:1356367072
Name:GALLAGHER, PATRICIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
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 1:24 E 12TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4403
Mailing Address - Country:US
Mailing Address - Phone:212-691-9281
Mailing Address - Fax:212-645-4349
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4403
Practice Address - Country:US
Practice Address - Phone:212-691-9281
Practice Address - Fax:212-645-4349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR030011-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN31111Medicare ID - Type Unspecified