Healthcare Provider Details

I. General information

NPI: 1588898290
Provider Name (Legal Business Name): JAMES PETER GALLIHER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 WESTERN AVE
ALBANY NY
12203-1617
US

IV. Provider business mailing address

523 WESTERN AVE
ALBANY NY
12203-1617
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-7777
  • Fax: 518-489-7771
Mailing address:
  • Phone: 518-489-7777
  • Fax: 518-489-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR058124-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: