Provider Demographics
NPI:1871676361
Name:GALLEGOS, ANITA (LCSW)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N. 3RD STREET
Mailing Address - Street 2:SUITE 2008
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-264-4600
Mailing Address - Fax:602-264-7325
Practice Address - Street 1:2700 N. 3RD STREET
Practice Address - Street 2:SUITE 2008
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-264-4600
Practice Address - Fax:602-264-7325
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT141481041C0700X
CO8831041C0700X
AZ134131041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical