Provider Demographics
NPI:1578771929
Name:GALLIGAN, ROBERT B JR (MED, LPCC, LADAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:GALLIGAN
Suffix:JR
Gender:M
Credentials:MED, LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CARLISLE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-0000
Mailing Address - Country:US
Mailing Address - Phone:505-332-2377
Mailing Address - Fax:505-274-7279
Practice Address - Street 1:1400 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5658
Practice Address - Country:US
Practice Address - Phone:505-332-2377
Practice Address - Fax:505-274-7279
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3442101YA0400X
NM0080391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3442OtherLADAC
NM0080391OtherLPCC