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General NPI Number Information
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NPI Number | 1124198783
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Entity Type | Individual
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Provider Name | PAMELA ANN GALLAGHER L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 118 PROSPECT ST SUITE #3
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4473
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Country | US
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Telephone | 201-493-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MIDLAND AVE APT. 12B
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04740300
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License Number State | NJ
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