Provider Demographics
NPI:1629726039
Name:GALLAGHER, THERESA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:DAWN
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 1:214 E 24TH ST
Mailing Address - Street 2:PHG
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3900
Mailing Address - Country:US
Mailing Address - Phone:740-359-2427
Mailing Address - Fax:
Practice Address - Street 1:214 E 24TH ST
Practice Address - Street 2:PHG
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3900
Practice Address - Country:US
Practice Address - Phone:740-359-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024579103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist