Individual
MISS ANN K. GALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
Mailing address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
LCS65668
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891980561
NPI
CA
01
—
LCS65668
MEDICAL LICENSE
CA
Enumeration date
09/06/2007
Last updated
10/10/2019
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