Healthcare Provider Details

I. General information

NPI: 1801950209
Provider Name (Legal Business Name): CHARLES P. GALLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MOSSIDE BLVD SUITE 304
MONROEVILLE PA
15146-3540
US

IV. Provider business mailing address

2550 MOSSIDE BLVD SUITE 304
MONROEVILLE PA
15146-3540
US

V. Phone/Fax

Practice location:
  • Phone: 412-373-3471
  • Fax: 412-373-7324
Mailing address:
  • Phone: 412-373-3471
  • Fax: 412-373-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES P GALLO
Title or Position: OWNER
Credential: PH.D.
Phone: 412-373-3471