Provider Demographics
NPI:1386045193
Name:GALLO, NICHOLAS P (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:P
Last Name:GALLO
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 1:2675 EAST 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-4115
Mailing Address - Country:US
Mailing Address - Phone:216-771-6460
Mailing Address - Fax:216-623-0992
Practice Address - Street 1:2675 EAST 30TH STREET
Practice Address - Street 2:NERC
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-4115
Practice Address - Country:US
Practice Address - Phone:216-771-6460
Practice Address - Fax:216-623-0992
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1890103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid