Provider Demographics
NPI:1275249559
Name:GALLINI, RICHARD F (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:GALLINI
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 1:395 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-2309
Mailing Address - Country:US
Mailing Address - Phone:203-910-0000
Mailing Address - Fax:
Practice Address - Street 1:330 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3600
Practice Address - Country:US
Practice Address - Phone:203-202-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC112018000208103TS0200X
CT004497103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool