Provider Demographics
NPI:1336139005
Name:GALLEHER, GAY (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:GAY
Middle Name:
Last Name:GALLEHER
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 STATE ROAD
Mailing Address - Street 2:SUITE 9, BOX 266
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:207-443-1016
Mailing Address - Fax:
Practice Address - Street 1:579 BERRYS MILL ROAD
Practice Address - Street 2:
Practice Address - City:WEST BATH
Practice Address - State:ME
Practice Address - Zip Code:04530
Practice Address - Country:US
Practice Address - Phone:207-443-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist