Provider Demographics
NPI:1790479061
Name:PALMISANO, INGRID (LCSW)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:PALMISANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LAS OLAS BLVD UNIT 2103
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2772
Mailing Address - Country:US
Mailing Address - Phone:305-798-2983
Mailing Address - Fax:
Practice Address - Street 1:805 E BROWARD BLVD STE 301
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2046
Practice Address - Country:US
Practice Address - Phone:305-798-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW99961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical