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NPI Code Detail

MEDICARE: MRS. AMYSUE GALLAGHER LCSW

MEDICARE: MRS. AMYSUE GALLAGHER LCSW
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
1222Q00000XDevelopmental Therapist
21041C0700XClinical Social WorkerSW12155FL
3171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437581758
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMYSUE GALLAGHER LCSW
Provider Business Mailing Address
First Line : 910 N JEFFERSON ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-6810
Country : US
Telephone Number : 904-360-7022
Fax Number :
Provider Business Practice Location Address
First Line : 841 PRUDENTIAL DR STE 1900
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8373
Country : US
Telephone Number : 904-633-9020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2013
Last Update Date : 12/01/2021

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