Healthcare Provider Details

I. General information

NPI: 1871397604
Provider Name (Legal Business Name): ARTHUR GALLAGHER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 MEDFORD AVE
PATCHOGUE NY
11772-1240
US

IV. Provider business mailing address

PO BOX 51
STONY BROOK NY
11790-0051
US

V. Phone/Fax

Practice location:
  • Phone: 631-621-2744
  • Fax:
Mailing address:
  • Phone: 631-621-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: