MEDICARE: MS. LAURIE CLAIRE 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
1	1041C0700X	Clinical Social Worker	LCS13934	CA

General Provider Information

NPI Number	:	1407057219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE CLAIRE GALLAGHER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 16083
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96151-6083
Country	:	US
Telephone Number	:	530-542-2409
Fax Number	:	530-542-2791

Provider Business Practice Location Address
First Line	:	3320 SANDY WAY
Second Line	:	SUITE 4
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-8105
Country	:	US
Telephone Number	:	530-542-2409
Fax Number	:	530-542-2791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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