Provider Demographics
NPI:1932340353
Name:GALLIN, AIMEE Q (LCSW)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:Q
Last Name:GALLIN
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 1:228 HARDENBURG RD
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5310
Mailing Address - Country:US
Mailing Address - Phone:845-392-0787
Mailing Address - Fax:
Practice Address - Street 1:228 HARDENBURG RD
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5310
Practice Address - Country:US
Practice Address - Phone:845-392-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071191-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical