Provider Demographics
NPI:1134530843
Name:GALLAS, ELAINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:GALLAS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 BOSTON POST RD STE 8
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3236
Mailing Address - Country:US
Mailing Address - Phone:203-600-8900
Mailing Address - Fax:203-306-3003
Practice Address - Street 1:236 BOSTON POST RD STE 8
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3236
Practice Address - Country:US
Practice Address - Phone:203-600-8900
Practice Address - Fax:203-306-3003
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT003439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health