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General NPI Number Information
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NPI Number | 1386119618
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Entity Type | Individual
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Provider Name | KRISTY GARGANO MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 10/13/2018
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Provider Practice Location Address
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Address Line | 2100 MANCHESTER RD
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City | WHEATON
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State | IL
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Zip | 60187-4579
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Country | US
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Telephone | 630-923-5114
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Fax |
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Provider Business Mailing Address
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Address Line | 300 DIVISION ST
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1108
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Country | US
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Telephone | 630-577-7506
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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 | 150.102673
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.102673
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License Number State | IL
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