Provider Demographics
NPI:1295462935
Name:GALLAGHER, COLLEEN ERIN (MA, LBS, BCBA)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ERIN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MA, LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PHEASANT RUN STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1877
Mailing Address - Country:US
Mailing Address - Phone:215-579-0670
Mailing Address - Fax:
Practice Address - Street 1:170 PHEASANT RUN STE 100
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1877
Practice Address - Country:US
Practice Address - Phone:215-579-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006057103K00000X
PA1-24-72848103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst