1750647723 NPI number — MR. RICHARD SEBASTIAN GALLAGHER LMFT

Table of content: MR. RICHARD SEBASTIAN GALLAGHER LMFT (NPI 1750647723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750647723 NPI number — MR. RICHARD SEBASTIAN GALLAGHER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER
Provider First Name:
RICHARD
Provider Middle Name:
SEBASTIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750647723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14852-4023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-227-2252
Provider Business Mailing Address Fax Number:
607-235-5003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 S MEADOW ST
Provider Second Line Business Practice Location Address:
SUITE 450 #1096
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-5398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-227-2252
Provider Business Practice Location Address Fax Number:
607-235-5003
Provider Enumeration Date:
04/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  001017 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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