Provider Demographics
NPI:1417528837
Name:GALLAGHER, MARY (LPC, RD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LPC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 REDMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3030
Mailing Address - Country:US
Mailing Address - Phone:908-596-1066
Mailing Address - Fax:732-389-0611
Practice Address - Street 1:1 DAYBREAK CT
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3763
Practice Address - Country:US
Practice Address - Phone:908-596-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered