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NPI Code Detail

MEDICARE: BROOKE GALLAGHER LCSW

MEDICARE: BROOKE GALLAGHER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904020036VA

General Provider Information

NPI Number : 1205779477
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE GALLAGHER LCSW
Provider Business Mailing Address
First Line : 9228 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-4162
Country : US
Telephone Number : 804-695-8120
Fax Number : 804-695-8122
Provider Business Practice Location Address
First Line : 9228 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-4162
Country : US
Telephone Number : 804-695-8120
Fax Number : 804-695-8122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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