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Organization

KMG THERAPY AND CONSULTING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARIA M GALLAGHER LCSW (MEMBER)
(860) 917-1779
Entity
Organization

Contact information

Practice address
481 GOLD STAR HWY, SUITE 301, GROTON, CT 06340-6702
(860) 917-1779
(860) 447-8122
Mailing address
1075 E LAKE RD, OAKDALE, CT 06370-1818
(860) 917-1779
(860) 447-8122

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8823
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006568
VALUEOPTIONS CT BHP
CT
05
008056500
CT
01
13515495
COUNCIL FOR AFFORDABLE QUALITY HEALTH (CAQH)
CT
01
544181
MANAGED HEALTH NETWORK (MHN)
CT
01
D300184136
MEDICARE PTAN
CT
Enumeration date
11/23/2015
Last updated
11/23/2015
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