Basic Information
| Provider Information | |||||||||
| NPI: | 1548769854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLIGAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 CENTRAL MAINE XING | ||||||||
| Address2: | |||||||||
| City: | GARDINER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043456320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075826608 | ||||||||
| FaxNumber: | 2075822258 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 CENTRAL MAINE XING | ||||||||
| Address2: | |||||||||
| City: | GARDINER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043456320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075826608 | ||||||||
| FaxNumber: | 2075822258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2018 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 116296 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | LC20106 | ME | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.