Healthcare Provider Details

I. General information

NPI: 1508076605
Provider Name (Legal Business Name): JUDY ANN GALLEGO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 BARN VALLEY LN
LINCOLN CA
95648-8607
US

IV. Provider business mailing address

1537 BARN VALLEY LN
LINCOLN CA
95648-8607
US

V. Phone/Fax

Practice location:
  • Phone: 916-852-5835
  • Fax:
Mailing address:
  • Phone: 916-852-5835
  • Fax: 916-852-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: