MEDICARE: SEAN M GILLIGAN 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	44SC05691800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	089271-1	OTHER	NY	LMSW

General Provider Information

NPI Number	:	1679917173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN M GILLIGAN LCSW

Provider Business Mailing Address
First Line	:	111 S ORANGE AVE STE 28
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1931
Country	:	US
Telephone Number	:	646-265-3634
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S ORANGE AVE STE 28
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1931
Country	:	US
Telephone Number	:	646-265-3634
Fax Number	:

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

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	07/21/2022

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