Provider Demographics
NPI:1386083301
Name:GALLANT, AMY (MS, CGC, MBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GALLANT
Suffix:
Gender:F
Credentials:MS, CGC, MBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:1. ROONEY 2. MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 BROOK PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1001
Mailing Address - Country:US
Mailing Address - Phone:860-707-4789
Mailing Address - Fax:
Practice Address - Street 1:9 BROOK PASTURE LN
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-1001
Practice Address - Country:US
Practice Address - Phone:860-707-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC059170300000X
CAGC000544170300000X
NJ25MJ00077800170300000X
CT45170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS