Provider Demographics
NPI:1427768522
Name:GALLIMORE, MICHELLE S
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 CRESTON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-2630
Mailing Address - Country:US
Mailing Address - Phone:516-510-1546
Mailing Address - Fax:
Practice Address - Street 1:2229 CRESTON AVE APT 6
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-2630
Practice Address - Country:US
Practice Address - Phone:516-510-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4887261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional