Provider Demographics
NPI:1588621643
Name:GALLAGHER, LISA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:SUITE 104, BOX 145
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1918
Mailing Address - Country:US
Mailing Address - Phone:781-277-4677
Mailing Address - Fax:855-457-1210
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-277-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00390103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1039830Medicare ID - Type UnspecifiedPROVIDER NUMBER