Provider Demographics
NPI:1326610254
Name:PALKO, PATRICIA STARR
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:STARR
Last Name:PALKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3208
Mailing Address - Country:US
Mailing Address - Phone:201-919-6322
Mailing Address - Fax:
Practice Address - Street 1:708 W MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3208
Practice Address - Country:US
Practice Address - Phone:201-919-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00779600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional