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General NPI Number Information
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NPI Number | 1003117821
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Entity Type | Individual
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Provider Name | GUILLERMO ENRIQUE GALLEGOS PH. D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 5 FIR CT STE 2
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City | OAKLAND
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State | NJ
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Zip | 07436-1821
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Country | US
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Telephone | 908-239-2338
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Fax | 201-933-1326
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Provider Business Mailing Address
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Address Line | 336 MOUNTAIN WAY
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City | RUTHERFORD
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State | NJ
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Zip | 07070-2817
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Country | US
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Telephone | 908-239-2338
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Fax | 201-933-1326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | SIOO2556
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 16943
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License Number State | NY
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