Provider Demographics
NPI:1811942162
Name:GALLERY, DANIEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GALLERY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:GALLERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:26 CITY HALL MALL FL 9
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4754
Mailing Address - Country:US
Mailing Address - Phone:781-306-5463
Mailing Address - Fax:781-306-5015
Practice Address - Street 1:39 PILLON RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4238
Practice Address - Country:US
Practice Address - Phone:617-763-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4858103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04885OtherBLUE CROSS
MAW04885OtherBLUE CROSS