Provider Demographics
NPI:1376295238
Name:PALACIOS, ODARIS (MHC)
Entity Type:Individual
Prefix:
First Name:ODARIS
Middle Name:
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 1:5956 MADISON ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3906
Mailing Address - Country:US
Mailing Address - Phone:718-710-8344
Mailing Address - Fax:
Practice Address - Street 1:102 PILLING ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1610
Practice Address - Country:US
Practice Address - Phone:718-602-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program