Provider Demographics
NPI:1396805099
Name:GALLO PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:GALLO PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:781-278-6761
Mailing Address - Street 1:800 WASHINGTON STREET
Mailing Address - Street 2:DRAPER 3
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3487
Mailing Address - Country:US
Mailing Address - Phone:781-278-6761
Mailing Address - Fax:781-278-6836
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:DRAPER 3
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3487
Practice Address - Country:US
Practice Address - Phone:781-278-6761
Practice Address - Fax:781-278-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2205352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty