Provider Demographics
NPI:1558034694
Name:GALLAGHER, CYNTHIA ELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 NAPLES PLAZA
Mailing Address - Street 2:SUITE #205
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5074
Mailing Address - Country:US
Mailing Address - Phone:310-226-8443
Mailing Address - Fax:
Practice Address - Street 1:5848 NAPLES PLAZA
Practice Address - Street 2:SUITE #205
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5074
Practice Address - Country:US
Practice Address - Phone:310-226-8443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical