Provider Demographics
NPI:1376891754
Name:GALLEGOS GREENWICH, AUTUMN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:MARIE
Last Name:GALLEGOS GREENWICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AUTUMN
Other - Middle Name:MARIE
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:400 FORT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1159
Mailing Address - Country:US
Mailing Address - Phone:585-275-6671
Mailing Address - Fax:585-273-1082
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-275-6671
Practice Address - Fax:585-273-1082
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19439103TC0700X
NY019439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical