Basic Information
| Provider Information | |||||||||
| NPI: | 1508202490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALUMBO | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 EAST 127TH STREET | ||||||||
| Address2: | APT C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884825 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | B52, RM. 139 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2013 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 081743-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.