Provider Demographics
NPI:1962529727
Name:GALLOWAY, MARC B (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:B
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 E MERRICK RD UNIT 2
Mailing Address - Street 2:SUITE # 161
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4056
Mailing Address - Country:US
Mailing Address - Phone:516-528-5876
Mailing Address - Fax:
Practice Address - Street 1:19 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5120
Practice Address - Country:US
Practice Address - Phone:516-528-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57052131041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool