Provider Demographics
NPI:1417496050
Name:PALMIERI, MARK JOSEPH (PSYD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:PALMIERI
Suffix:
Gender:M
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2218
Mailing Address - Country:US
Mailing Address - Phone:860-430-1762
Mailing Address - Fax:860-430-1767
Practice Address - Street 1:2300 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2218
Practice Address - Country:US
Practice Address - Phone:860-430-1762
Practice Address - Fax:860-430-1767
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002929103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist