MEDICARE: MS. JOAN H. GALLAGHER LSW

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	104100000X	Social Worker	SW006089E	PA

General Provider Information

NPI Number	:	1407066616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN H. GALLAGHER LSW

Provider Business Mailing Address
First Line	:	8337 HIGH SCHOOL RD
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2027
Country	:	US
Telephone Number	:	215-771-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 YORKTOWN PLZ
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1427
Country	:	US
Telephone Number	:	215-771-0796
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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