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NPI Code Detail

MEDICARE: ILENE S GALLNER-TOLLER LCSW-C

MEDICARE: ILENE S GALLNER-TOLLER LCSW-C
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 Worker04011MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
153085702OTHERMDCAREFIRST BCBS
2T541-0031OTHERMDBCBS-DC REGIONAL #
3272281OTHERMDCOMPSYCH
4226089OTHERMDKAISER
5PVPB134858OTHERMDAPS HEALTHCARE

General Provider Information

NPI Number : 1962427963
Entity Type Code : Individual
Provider Name (Legal Business Name) : ILENE S GALLNER-TOLLER LCSW-C
Provider Business Mailing Address
First Line : 4623 FALLS RD
Second Line :
City : BALTIMORE
State : MD
Zip : 21209-4914
Country : US
Telephone Number : 410-366-1980
Fax Number : 410-366-8530
Provider Business Practice Location Address
First Line : 10451 TWIN RIVERS RD
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-2388
Country : US
Telephone Number : 410-977-3557
Fax Number : 410-364-1791
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 11/26/2007

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Directions to “ ILENE S GALLNER-TOLLER LCSW-C” Practice Location

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