Provider Demographics
NPI:1790949675
Name:PALM, PHYLLIS W (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:W
Last Name:PALM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3710
Mailing Address - Country:US
Mailing Address - Phone:646-265-8570
Mailing Address - Fax:
Practice Address - Street 1:125 RIVERSIDE DR
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3710
Practice Address - Country:US
Practice Address - Phone:646-265-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7825103T00000X
NJ2960103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist