Provider Demographics
NPI:1497274518
Name:PALO, JENNIFER (MA LCDP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PALO
Suffix:
Gender:F
Credentials:MA LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OPPER AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-2744
Mailing Address - Country:US
Mailing Address - Phone:401-793-1468
Mailing Address - Fax:
Practice Address - Street 1:55 OPPER AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-2744
Practice Address - Country:US
Practice Address - Phone:401-793-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00706101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)