Provider Demographics
NPI:1922291681
Name:GALLAGHER, ROSINA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSINA
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4316
Mailing Address - Country:US
Mailing Address - Phone:773-465-2711
Mailing Address - Fax:773-465-5644
Practice Address - Street 1:6728 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4316
Practice Address - Country:US
Practice Address - Phone:773-465-2711
Practice Address - Fax:773-465-5644
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL487640Medicare PIN