Provider Demographics
NPI:1750439121
Name:GALLEY, JOANN M (PSY D)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:M
Last Name:GALLEY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:JOANNE
Other - Middle Name:M
Other - Last Name:CALDERONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:435 WEST 57 STREET
Mailing Address - Street 2:#9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1739
Mailing Address - Country:US
Mailing Address - Phone:646-459-3405
Mailing Address - Fax:646-459-3989
Practice Address - Street 1:590 AVENUE OF AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:646-459-3405
Practice Address - Fax:646-459-3989
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012664103T00000X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012664OtherNY EDUC DEPT