Healthcare Provider Details

I. General information

NPI: 1942565767
Provider Name (Legal Business Name): SIOMARA GITTENS-GALLOWAY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL CENTER BLVD. STE. N804
MARRERO LA
70072-3147
US

IV. Provider business mailing address

1111 MEDICAL CENTER BLVD. STE. N804
MARRERO LA
70072-3147
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-6360
  • Fax: 504-349-6363
Mailing address:
  • Phone: 504-349-6360
  • Fax: 504-349-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7067
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: