Provider Demographics
NPI:1235250838
Name:GALLO, DENNIS P (PHD, CLINICAL PSYCHO)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:P
Last Name:GALLO
Suffix:
Gender:M
Credentials:PHD, CLINICAL PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HARRIET ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4705
Mailing Address - Country:US
Mailing Address - Phone:631-422-2962
Mailing Address - Fax:631-422-2962
Practice Address - Street 1:104 HARRIET ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4705
Practice Address - Country:US
Practice Address - Phone:631-422-2962
Practice Address - Fax:631-422-2962
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
008966399OtherGHI
DR7076OtherOXFORD HEALTH PLANS
V5529OtherBLUE CROSS BLUE SHIELD
0004389686OtherAETNA
A058227OtherVALUE OPTIONS
V5529OtherBLUE CROSS BLUE SHIELD
NYV55291Medicare ID - Type Unspecified