Provider Demographics
NPI:1760814388
Name:GALE, THOMAS VINCENT (MA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:VINCENT
Last Name:GALE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2308
Mailing Address - Country:US
Mailing Address - Phone:321-474-0606
Mailing Address - Fax:
Practice Address - Street 1:1100 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-2308
Practice Address - Country:US
Practice Address - Phone:321-474-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor