Provider Demographics
NPI:1316554280
Name:PALACIOS, STEPHANIE K (MHC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 55TH AVE APT 5K
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4515
Mailing Address - Country:US
Mailing Address - Phone:347-341-3222
Mailing Address - Fax:
Practice Address - Street 1:6344 SAUNDERS ST STE 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11374-2044
Practice Address - Country:US
Practice Address - Phone:347-341-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health