Provider Demographics
NPI:1275005563
Name:GALLANT, KATLYN MARIE (MA, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:MARIE
Last Name:GALLANT
Suffix:
Gender:F
Credentials:MA, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5197
Mailing Address - Country:US
Mailing Address - Phone:781-719-7746
Mailing Address - Fax:
Practice Address - Street 1:418 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-5197
Practice Address - Country:US
Practice Address - Phone:781-719-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4291103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst