Provider Demographics
NPI:1043802507
Name:PALUMBO, JENNIFER (LCDC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 MONTANO RD NW STE G1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1826
Mailing Address - Country:US
Mailing Address - Phone:505-999-0203
Mailing Address - Fax:505-521-5161
Practice Address - Street 1:6300 MONTANO RD NW STE G1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1826
Practice Address - Country:US
Practice Address - Phone:505-999-0203
Practice Address - Fax:505-521-5161
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10992101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)