Individual
BETTY LYNN GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
134 N 4TH ST, BROOKLYN, NY 11249-3296
(646) 450-7748
Mailing address
445 SMITH RIDGE RD, SOUTH SALEM, NY 10590-2626
(203) 216-2832
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
099880
NY
104100000X
Social Worker
4826
CT
1041C0700X
Clinical Social Worker
089.0137083
VT
1041C0700X
Clinical Social Worker
Primary
099537
NY
1041C0700X
Clinical Social Worker
15443
CT
Other
Enumeration date
10/18/2018
Last updated
05/11/2026
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