Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 002394 | CT |
N | 103G00000X | Clinical Psychologist | 002394 | CT |
N | 103TC0700X | Clinical Psychologist | 002394 | CT |
N | 103TF0200X | Forensic Psychologist | 002394 | CT |
NPI | 1205991957 |
---|---|
Provider Name | Dr. Rafael Gallegos |
First Address | West Hartford, CT 06119-1554 |
Second Address | West Hartford, CT 06119-1554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2006 |
Last Update Date | 08/07/2007 |