Provider Demographics
NPI:1508174137
Name:PALUMBO, VINCENT JOSEPH JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:PALUMBO
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KETTLES LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1560
Mailing Address - Country:US
Mailing Address - Phone:631-758-4068
Mailing Address - Fax:
Practice Address - Street 1:3239 ROUTE 112
Practice Address - Street 2:STE 2
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1432
Practice Address - Country:US
Practice Address - Phone:631-758-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0335701041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool