Provider Demographics
NPI:1821379306
Name:PALKO, ELIZABETH FRANCISCA (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FRANCISCA
Last Name:PALKO
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 1:300 PRISON RD
Mailing Address - Street 2:
Mailing Address - City:REPRESA
Mailing Address - State:CA
Mailing Address - Zip Code:95671-3001
Mailing Address - Country:US
Mailing Address - Phone:831-678-5500
Mailing Address - Fax:
Practice Address - Street 1:300 PRISON RD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-9529
Practice Address - Country:US
Practice Address - Phone:916-985-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25803103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist