Provider Demographics
NPI:1154482545
Name:GALVIN, FRANKLIN JEROME (PHD)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:JEROME
Last Name:GALVIN
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 1:17 A CUSHING AVENUE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:617-288-2711
Mailing Address - Fax:
Practice Address - Street 1:529 PEARL STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02401
Practice Address - Country:US
Practice Address - Phone:508-580-2211
Practice Address - Fax:508-427-1772
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY7305PT103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W50259Medicare ID - Type Unspecified