Provider Demographics
NPI:1124175328
Name:GAGLIANO, NANCY LYNN (LICSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 NW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5235
Mailing Address - Country:US
Mailing Address - Phone:206-218-3016
Mailing Address - Fax:
Practice Address - Street 1:16000 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 360
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1742
Practice Address - Country:US
Practice Address - Phone:206-218-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical