Provider Demographics
NPI:1285986620
Name:GALLAGHER, CARLY (LMSW)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:CONSTANTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:79 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 GLENRIDGE RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4523
Practice Address - Country:US
Practice Address - Phone:518-399-6446
Practice Address - Fax:518-952-8109
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086393104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03008239Medicaid