Provider Demographics
NPI:1659246049
Name:GALLO, JADE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 MERROW RD STE E
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3974
Mailing Address - Country:US
Mailing Address - Phone:860-830-7838
Mailing Address - Fax:860-454-0667
Practice Address - Street 1:392 MERROW RD STE E
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3974
Practice Address - Country:US
Practice Address - Phone:860-830-7838
Practice Address - Fax:860-454-0667
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health