Provider Demographics
NPI:1134468754
Name:PALMISANO, KENNETH (CADC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:PALMISANO
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 COUNTY AVE
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2605
Mailing Address - Country:US
Mailing Address - Phone:201-583-7100
Mailing Address - Fax:201-583-7112
Practice Address - Street 1:595 COUNTY AVE
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2605
Practice Address - Country:US
Practice Address - Phone:201-583-7100
Practice Address - Fax:201-583-7112
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00106300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)