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NPI Code Detail

MEDICARE: POLLY BANERJEE GALLAGHER

MEDICARE: POLLY BANERJEE GALLAGHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor2410CO

General Provider Information

NPI Number : 1871981134
Entity Type Code : Individual
Provider Name (Legal Business Name) : POLLY BANERJEE GALLAGHER
Provider Business Mailing Address
First Line : 1501 YARMOUTH AVE
Second Line :
City : BOULDER
State : CO
Zip : 80304-0564
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1501 YARMOUTH AVE
Second Line :
City : BOULDER
State : CO
Zip : 80304-0564
Country : US
Telephone Number : 303-786-9314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2015
Last Update Date : 01/08/2015

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Directions to “ POLLY BANERJEE GALLAGHER ” Practice Location

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