MEDICARE: MR. JOHN PAUL GALLAGHER L.C.S.W.

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	149009132	IL
2	1041C0700X	Clinical Social Worker	LCSW66517	CA

General Provider Information

NPI Number	:	1669580296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN PAUL GALLAGHER L.C.S.W.

Provider Business Mailing Address
First Line	:	801 E TAHQUITZ CANYON WAY
Second Line	:	202
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6763
Country	:	US
Telephone Number	:	760-325-4088
Fax Number	:	760-778-3781

Provider Business Practice Location Address
First Line	:	801 E TAHQUITZ CANYON WAY
Second Line	:	202
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6763
Country	:	US
Telephone Number	:	760-325-4088
Fax Number	:	760-778-3781

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/28/2015

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