Basic Information
| Provider Information | |||||||||
| NPI: | 1083158224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLEGOS | ||||||||
| FirstName: | SONIA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 BAILEY AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | NEEDLES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923633105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603269313 | ||||||||
| FaxNumber: | 7603262864 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 BAILEY AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | NEEDLES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923633105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603269313 | ||||||||
| FaxNumber: | 7603262864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2016 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW31554 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW31554 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 76067 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.