MEDICARE: DR. DEBORAH LYNN GALLO PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY15480	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831109214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH LYNN GALLO PH.D.

Provider Business Mailing Address
First Line	:	21241 VENTURA BLVD
Second Line	:	SUITE 180
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2108
Country	:	US
Telephone Number	:	818-372-7902
Fax Number	:

Provider Business Practice Location Address
First Line	:	21241 VENTURA BLVD
Second Line	:	SUITE 180
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2108
Country	:	US
Telephone Number	:	818-372-7902
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/01/2021

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