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General NPI Number Information
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NPI Number | 1780879452
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Entity Type | Individual
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Provider Name | JEANNETTE MARIE GAGLIARDI LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 123 EGG HARBOR RD SUITE 202
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City | SEWELL
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State | NJ
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Zip | 08080-9406
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Country | US
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Telephone | 856-347-0445
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Fax | 856-228-1096
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Provider Business Mailing Address
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Address Line | 123 EGG HARBOR RD STE 202 TOWER COMMONS OFFICE COMPLEX, BUILDING 200
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City | SEWELL
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State | NJ
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Zip | 08080-9406
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Country | US
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Telephone | 856-347-0445
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Fax | 856-228-1096
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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 | 44SC05332100
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License Number State | NJ
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