Provider Demographics
NPI:1558348920
Name:PALUMBO, ANTHONY JAMES (PHD LICSW)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:PHD LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2769
Mailing Address - Country:US
Mailing Address - Phone:508-295-4529
Mailing Address - Fax:508-295-4529
Practice Address - Street 1:18 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2769
Practice Address - Country:US
Practice Address - Phone:508-295-4529
Practice Address - Fax:508-295-4529
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10167581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300989Medicaid
MA1300989Medicaid