Provider Demographics
NPI:1346816592
Name:GALLIGAN, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GALLIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOSCAWEN
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1328
Mailing Address - Country:US
Mailing Address - Phone:603-753-1014
Mailing Address - Fax:
Practice Address - Street 1:30 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSCAWEN
Practice Address - State:NH
Practice Address - Zip Code:03303-1328
Practice Address - Country:US
Practice Address - Phone:603-753-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator