Basic Information
| Provider Information | |||||||||
| NPI: | 1649604430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLAGHER | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 92 DENTON AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115181524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165090609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115503718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164855710 | ||||||||
| FaxNumber: | 5164854225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2013 | ||||||||
| LastUpdateDate: | 08/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 088485 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.