MEDICARE: DR. GAY GALLEHER PHD, A.B.P.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS1058	ME

General Provider Information

NPI Number	:	1336139005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAY GALLEHER PHD, A.B.P.P.

Provider Business Mailing Address
First Line	:	10 STATE ROAD
Second Line	:	SUITE 9, BOX 266
City	:	BATH
State	:	ME
Zip	:	04530
Country	:	US
Telephone Number	:	207-443-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	579 BERRYS MILL ROAD
Second Line	:
City	:	WEST BATH
State	:	ME
Zip	:	04530
Country	:	US
Telephone Number	:	207-443-1016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/21/2012

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