Provider Demographics
NPI:1770862112
Name:GALLAGHER, MARIBETH T (MS, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:T
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MS, RN, PMHNP-BC
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Mailing Address - Street 1:14202 N 70TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3484
Mailing Address - Country:US
Mailing Address - Phone:602-636-2220
Mailing Address - Fax:602-530-6902
Practice Address - Street 1:1510 E FLOWER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5698
Practice Address - Country:US
Practice Address - Phone:602-636-2220
Practice Address - Fax:602-530-6902
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0390033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health