Provider Demographics
NPI:1427713627
Name:GALLAGHER, ELEONORA V (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELEONORA
Middle Name:V
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4300
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-1500
Mailing Address - Country:US
Mailing Address - Phone:917-703-3840
Mailing Address - Fax:
Practice Address - Street 1:4000 ROUTE 66 STE 331
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7300
Practice Address - Country:US
Practice Address - Phone:732-988-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213-079390200000X
NJ35SI00729700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program