MEDICARE: AIMEE Q. GALLIN L.C.S.W

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	071191-1	NY

General Provider Information

NPI Number	:	1932340353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE Q. GALLIN L.C.S.W

Provider Business Mailing Address
First Line	:	228 HARDENBURG RD
Second Line	:
City	:	ULSTER PARK
State	:	NY
Zip	:	12487-5310
Country	:	US
Telephone Number	:	845-392-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 HARDENBURG RD
Second Line	:
City	:	ULSTER PARK
State	:	NY
Zip	:	12487-5310
Country	:	US
Telephone Number	:	845-392-0787
Fax Number	:

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

Provider Enumeration Date	:	03/14/2009
Last Update Date	:	03/14/2009

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