Provider Demographics
NPI:1316148984
Name:GALLAGHER, DANIEL HUGH (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:HUGH
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 MILLBURN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2640
Mailing Address - Country:US
Mailing Address - Phone:973-762-2880
Mailing Address - Fax:973-762-1304
Practice Address - Street 1:2168 MILLBURN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2640
Practice Address - Country:US
Practice Address - Phone:973-762-2880
Practice Address - Fax:973-762-1304
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00276500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical