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NPI Code Detail

MEDICARE: DIANE GALLO LCSW

MEDICARE: DIANE GALLO 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 Worker038402-1NY

General Provider Information

NPI Number : 1871895938
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE GALLO LCSW
Provider Business Mailing Address
First Line : 640 76TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-3326
Country : US
Telephone Number : 917-658-5756
Fax Number :
Provider Business Practice Location Address
First Line : 38 WINTHROP PL
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3043
Country : US
Telephone Number : 718-667-3260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2010
Last Update Date : 11/23/2010

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