Provider Demographics
NPI:1376803007
Name:PALUMBO, BETH VIRGINIA (LCSW, RPT-S)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:VIRGINIA
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:LCSW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 BLUE SPRINGS RD NW
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1030
Mailing Address - Country:US
Mailing Address - Phone:678-542-7211
Mailing Address - Fax:
Practice Address - Street 1:3440 BLUE SPRINGS RD NW
Practice Address - Street 2:SUITE 304
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1030
Practice Address - Country:US
Practice Address - Phone:678-542-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0042541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical