Provider Demographics
NPI:1982302733
Name:GALLAGHER, CAITLIN MICHELLE (LBS)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MICHELLE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3132
Mailing Address - Country:US
Mailing Address - Phone:610-908-2923
Mailing Address - Fax:
Practice Address - Street 1:1720 WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3156
Practice Address - Country:US
Practice Address - Phone:215-350-7236
Practice Address - Fax:272-400-2026
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst