Provider Demographics
NPI:1215253521
Name:GALLAGHER, JUSTIN JAMES (BA)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:JAMES
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 FREDERICK ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02744-2214
Mailing Address - Country:US
Mailing Address - Phone:401-474-4915
Mailing Address - Fax:
Practice Address - Street 1:28 FREDERICK ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-2214
Practice Address - Country:US
Practice Address - Phone:401-474-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst