Provider Demographics
NPI:1760577647
Name:GALLAUDET, CHARLOTTE C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:C
Last Name:GALLAUDET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CARY
Other - Middle Name:
Other - Last Name:GALLAUDET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:64 PARKWAY RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3619
Mailing Address - Country:US
Mailing Address - Phone:914-384-2052
Mailing Address - Fax:
Practice Address - Street 1:64 PARKWAY RD APT 1A
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3619
Practice Address - Country:US
Practice Address - Phone:914-337-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7757103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY851198Medicaid