Provider Demographics
NPI:1326479320
Name:GALLAGHER, BOBBIE J (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:J
Last Name:GALLAGHER
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 1:508 CARROLL FOX RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4607
Mailing Address - Country:US
Mailing Address - Phone:732-295-5739
Mailing Address - Fax:732-840-1180
Practice Address - Street 1:508 CARROLL FOX RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4607
Practice Address - Country:US
Practice Address - Phone:732-295-5739
Practice Address - Fax:732-840-1180
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-10-7562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst