Provider Demographics
NPI:1720836984
Name:GALLAGHER, WILLIAM (CASAC-T, CRPA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:CASAC-T, CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 SEABURY ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4868
Mailing Address - Country:US
Mailing Address - Phone:347-781-2199
Mailing Address - Fax:
Practice Address - Street 1:770 GRAND BLVD STE 17
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5725
Practice Address - Country:US
Practice Address - Phone:631-919-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-5510175T00000X
NY38573101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist