Individual provider Active NPI

Robert Gallagher, LCSW

  • Clinical Social Worker
  • Staten Island, NY
National Provider Identifier
1972528727
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R045818-1 Issued in NY
Practice address
1110 South Ave Ste 46
Staten Island, NY 10314-3403
Phone
(718) 983-9200
Fax
(732) 617-8784
NPI assigned
Jul 13, 2006
Last updated
Feb 28, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X R045818-1 NY Primary

Addresses

Primary practice location

1110 South Ave Ste 46
Staten Island, NY 10314-3403

Mailing address

1110 South Ave Ste 46
Staten Island, NY 10314-3403
Phone (718) 983-9200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110830000003 NY Practitioner - Clinical Social Worker 1254501398 Practice locations: Staten Island, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1110 S Ave
Suite 46
Staten Island, NY 10314-3403
Phone (718) 983-9200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R045818-1NYMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1972528727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 SOUTH AVE STE 46",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143403",
            "telephone_number": "718-983-9200",
            "fax_number": "732-617-8784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 SOUTH AVE STE 46",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143403",
            "telephone_number": "718-983-9200",
            "fax_number": "732-617-8784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "ROBERT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R045818-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.