Provider Demographics
NPI:1457057770
Name:GAILLARD, BETH (LCSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GAILLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MEADOW PARK DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2623
Mailing Address - Country:US
Mailing Address - Phone:860-655-2222
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY BLDG 17A
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2519
Practice Address - Country:US
Practice Address - Phone:203-230-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT127771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical