Provider Demographics
NPI:1497093470
Name:PALUMBO, RICHARD VINCENT JR (MA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:VINCENT
Last Name:PALUMBO
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MARSHALL DRIFTWAY
Mailing Address - Street 2:
Mailing Address - City:HOPE VALLEY
Mailing Address - State:RI
Mailing Address - Zip Code:02832-1119
Mailing Address - Country:US
Mailing Address - Phone:413-454-2159
Mailing Address - Fax:
Practice Address - Street 1:1058 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879-2536
Practice Address - Country:US
Practice Address - Phone:401-789-1553
Practice Address - Fax:401-782-1313
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health