Provider Demographics
NPI:1346075777
Name:GALLIGAN, GEORGIA EVE (CASAC-T, BA)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:EVE
Last Name:GALLIGAN
Suffix:
Gender:F
Credentials:CASAC-T, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1420
Mailing Address - Country:US
Mailing Address - Phone:845-654-0777
Mailing Address - Fax:
Practice Address - Street 1:233 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4051
Practice Address - Country:US
Practice Address - Phone:917-476-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)