Provider Demographics
NPI:1093988172
Name:GALLO & ASSOCIATES PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:GALLO & ASSOCIATES PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:P
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:724-346-3838
Mailing Address - Street 1:60 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3432
Mailing Address - Country:US
Mailing Address - Phone:724-346-3838
Mailing Address - Fax:724-346-4339
Practice Address - Street 1:60 SNYDER RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3432
Practice Address - Country:US
Practice Address - Phone:724-346-3838
Practice Address - Fax:724-346-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002468L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014881690003Medicaid
PAR05722Medicare UPIN
PA0014881690003Medicaid