Provider Demographics
NPI:1912238353
Name:GALLAGHER, SUSAN F (LISW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 PORTAGE TRAIL EXT W
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2542
Mailing Address - Country:US
Mailing Address - Phone:330-923-3060
Mailing Address - Fax:330-923-7705
Practice Address - Street 1:556 PORTAGE TRAIL EXT W
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2542
Practice Address - Country:US
Practice Address - Phone:330-923-3060
Practice Address - Fax:330-923-7705
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-15851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical