Provider Demographics
NPI:1750647723
Name:GALLAGHER, RICHARD SEBASTIAN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SEBASTIAN
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4023
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14852-4023
Mailing Address - Country:US
Mailing Address - Phone:607-227-2252
Mailing Address - Fax:607-235-5003
Practice Address - Street 1:744 S MEADOW ST
Practice Address - Street 2:SUITE 450 #1096
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5398
Practice Address - Country:US
Practice Address - Phone:607-227-2252
Practice Address - Fax:607-235-5003
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist