Healthcare Provider Details

I. General information

NPI: 1811942162
Provider Name (Legal Business Name): DANIEL GALLERY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL GALLERY PSYD

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 PILLON RD
MILTON MA
02186-4238
US

IV. Provider business mailing address

26 CITY HALL MALL FL 9
MEDFORD MA
02155-4754
US

V. Phone/Fax

Practice location:
  • Phone: 617-763-3152
  • Fax:
Mailing address:
  • Phone: 781-306-5463
  • Fax: 781-306-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4858
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: