Healthcare Provider Details

I. General information

NPI: 1659636397
Provider Name (Legal Business Name): JUDY G GALLAGHER MA, LCMHC, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 W BROADWAY STE 200
DERRY NH
03038-2323
US

IV. Provider business mailing address

PO BOX 13
WEST PETERBOROUGH NH
03468-0013
US

V. Phone/Fax

Practice location:
  • Phone: 978-216-2770
  • Fax:
Mailing address:
  • Phone: 978-216-2770
  • Fax: 978-216-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4631
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0965
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: