Provider Demographics
NPI:1851011092
Name:GALLO, RYAN NICHOLAS (MHC-LP)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:NICHOLAS
Last Name:GALLO
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MCCLELLAN AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1860
Mailing Address - Country:US
Mailing Address - Phone:631-897-2119
Mailing Address - Fax:
Practice Address - Street 1:496 SMITHTOWN BYP STE 203
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5011
Practice Address - Country:US
Practice Address - Phone:631-371-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117573-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health