Healthcare Provider Details

I. General information

NPI: 1790874782
Provider Name (Legal Business Name): MELISSA ANN GALLIA BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOND STREET
ASBURY PARK NJ
07712-5939
US

IV. Provider business mailing address

1011 BOND ST
ASBURY PARK NJ
07712-5939
US

V. Phone/Fax

Practice location:
  • Phone: 732-869-2763
  • Fax: 732-897-9541
Mailing address:
  • Phone: 732-869-2763
  • Fax: 732-897-9541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: