Provider Demographics
NPI:1649302944
Name:CALLAGHAN, GAYLE MARIE (ATR-BC, LMFT, PSYD)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:MARIE
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:ATR-BC, LMFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3810
Mailing Address - Country:US
Mailing Address - Phone:323-869-9255
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH GARFIELD AVE
Practice Address - Street 2:BIENVENIDOS CHILDREN'S CENTER
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-869-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103TC0700XOtherPSY.D.