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General NPI Number Information
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NPI Number | 1588769699
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Entity Type | Individual
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Provider Name | KEVIN P GALLAGHER MS, LCMHC
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2 CHURCH ST SUITE 4G
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City | BURLINGTON
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State | VT
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Zip | 05401-4299
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Country | US
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Telephone | 802-651-7674
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Fax | 802-658-1777
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Provider Business Mailing Address
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Address Line | 48 NORTHSHORE DR
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City | BURLINGTON
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State | VT
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Zip | 05401-1250
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Country | US
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Telephone | 802-651-7674
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Fax | 802-658-1777
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | VT
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