Provider Demographics
NPI:1063405785
Name:GALLIANO, KARIN (PHD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:GALLIANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CROSS ST
Mailing Address - Street 2:111
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4877
Mailing Address - Country:US
Mailing Address - Phone:941-505-6162
Mailing Address - Fax:941-505-8604
Practice Address - Street 1:425 CROSS ST
Practice Address - Street 2:111
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4877
Practice Address - Country:US
Practice Address - Phone:941-505-6162
Practice Address - Fax:941-505-8604
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6197103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54712OtherBCBS
FLP27051Medicare UPIN
FLE5230YMedicare PIN
FLP00047787Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLE5230Medicare ID - Type Unspecified