Provider Demographics
NPI:1457107823
Name:RODRIGUEZ-GALLO, ANDREA (MS, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RODRIGUEZ-GALLO
Suffix:
Gender:F
Credentials:MS, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 SHETLAND WAY
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1551
Mailing Address - Country:US
Mailing Address - Phone:856-313-9590
Mailing Address - Fax:
Practice Address - Street 1:630 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:856-547-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00685900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health