Healthcare Provider Details

I. General information

NPI: 1306988563
Provider Name (Legal Business Name): BONNIE GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

IV. Provider business mailing address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

V. Phone/Fax

Practice location:
  • Phone: 202-464-9200
  • Fax: 202-464-5740
Mailing address:
  • Phone: 202-464-9200
  • Fax: 202-464-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302579
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: