Provider Demographics
NPI:1558420422
Name:PALERMO, CHRISTINE (MHR)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PALERMO
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S 74TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4615
Mailing Address - Country:US
Mailing Address - Phone:402-391-2222
Mailing Address - Fax:402-391-1057
Practice Address - Street 1:212 S 74TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4615
Practice Address - Country:US
Practice Address - Phone:402-391-2222
Practice Address - Fax:402-391-1057
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024950100Medicaid