Provider Demographics
NPI:1255743522
Name:GALIANO, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GALIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2506
Mailing Address - Country:US
Mailing Address - Phone:973-809-3709
Mailing Address - Fax:
Practice Address - Street 1:2 SPLIT ROCK DR STE 5
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1244
Practice Address - Country:US
Practice Address - Phone:833-494-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00637400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist