Provider Demographics
NPI:1720294671
Name:GALLE, SUSANA ALICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:ALICIA
Last Name:GALLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 18TH ST NW
Mailing Address - Street 2:212
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6515
Mailing Address - Country:US
Mailing Address - Phone:202-429-9552
Mailing Address - Fax:
Practice Address - Street 1:1325 18TH ST NW
Practice Address - Street 2:212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6515
Practice Address - Country:US
Practice Address - Phone:202-429-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical