Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 16943 | NY |
N | 103TC0700X | Clinical Psychologist | 16943 | NY |
Y | 103G00000X | Clinical Psychologist | SIOO2556 | NJ |
Y | 103TC0700X | Clinical Psychologist | SIOO2556 | NJ |
NPI | 1003117821 |
---|---|
Provider Name | Dr. Guillermo Enrique Gallegos |
First Address | Rutherford, NJ 07070-2817 |
Second Address | Oakland, NJ 07436-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 10/11/2010 |