Provider Demographics
NPI:1033210414
Name:GALLANT, ROBERT B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:GALLANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE #456J
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-921-4000
Mailing Address - Fax:978-921-7530
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE #456J
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-921-4000
Practice Address - Fax:978-921-7530
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7812103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2165868OtherCIGNA
MAW06226OtherBC/BS
MAW51148Medicare ID - Type Unspecified