MEDICARE: MICHAEL GALLAGHER

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	SW8263	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BZ595A	OTHER	FL	PTAN
2	Z01UD	OTHER	FL	BCBS
3	674627	OTHER	FL	VALUE OPTIONS

General Provider Information

NPI Number	:	1942612791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL GALLAGHER

Provider Business Mailing Address
First Line	:	422 NORTHLAKE DR
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5122
Country	:	US
Telephone Number	:	561-389-9450
Fax Number	:	954-366-3075

Provider Business Practice Location Address
First Line	:	422 NORTHLAKE DR
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5122
Country	:	US
Telephone Number	:	561-389-9450
Fax Number	:	954-366-3075

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL GALLAGHER
Credential	:	LCSW
Telephone Number	:	561-389-9450

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	05/28/2014

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