MEDICARE: KATHRYN REBECCA FORTUNE-GALLAGHER LMSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	097803-01	NY
2	1041C0700X	Clinical Social Worker	SWB-2025-0561.	NM
3	104100000X	Social Worker	6801067347	MI

General Provider Information

NPI Number	:	1285914119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN REBECCA FORTUNE-GALLAGHER LMSW, ACSW

Provider Business Mailing Address
First Line	:	2623 BLUE HERON PL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4392
Country	:	US
Telephone Number	:	734-260-3777
Fax Number	:	999-999-9999

Provider Business Practice Location Address
First Line	:	2623 BLUE HERON PL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4392
Country	:	US
Telephone Number	:	734-260-3777
Fax Number	:	999-999-9999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	01/08/2026

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