Provider Demographics
NPI:1407269210
Name:PALERMO, DANIELLA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:PALERMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLA
Other - Middle Name:
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:167 POINT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-793-8808
Practice Address - Fax:401-793-8851
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD158952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry