Provider Demographics
NPI:1134704729
Name:GALLETLEY, FAITH E (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:FAITH
Middle Name:E
Last Name:GALLETLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SEWAREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07077-1229
Mailing Address - Country:US
Mailing Address - Phone:732-947-0275
Mailing Address - Fax:
Practice Address - Street 1:330 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1325
Practice Address - Country:US
Practice Address - Phone:908-654-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-47551103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst