Provider Demographics
NPI:1518002997
Name:GALLANT, DAVID H (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:GALLANT
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 1:199 COOLIDGE AVENUE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1572
Mailing Address - Country:US
Mailing Address - Phone:617-926-9971
Mailing Address - Fax:
Practice Address - Street 1:199 COOLIDGE AVENUE
Practice Address - Street 2:SUITE 703
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1572
Practice Address - Country:US
Practice Address - Phone:617-926-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01751OtherBCBS
MAW01751OtherBCBS