Provider Demographics
NPI:1073665410
Name:PALERMO, MARION E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:E
Last Name:PALERMO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINECREST DR UNIT 7
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2936
Mailing Address - Country:US
Mailing Address - Phone:424-634-0234
Mailing Address - Fax:802-878-4404
Practice Address - Street 1:15 PINECREST DR UNIT 7
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2936
Practice Address - Country:US
Practice Address - Phone:424-634-0234
Practice Address - Fax:802-878-4404
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 106H00000X
VT048-0000917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016742Medicaid
VT1016742Medicaid