Provider Demographics
NPI:1497180327
Name:LORI-ANN PALAZZO MHC PC
Entity Type:Organization
Organization Name:LORI-ANN PALAZZO MHC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-892-0002
Mailing Address - Street 1:3188 WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1440
Mailing Address - Country:US
Mailing Address - Phone:718-892-0002
Mailing Address - Fax:646-403-3699
Practice Address - Street 1:2190 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1201
Practice Address - Country:US
Practice Address - Phone:718-892-0002
Practice Address - Fax:646-403-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005091101YM0800X, 103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005091OtherLMHC LICENSE