Provider Demographics
NPI:1942614086
Name:PALACIOS, ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ELIZABETH ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2965
Mailing Address - Country:US
Mailing Address - Phone:774-239-2040
Mailing Address - Fax:
Practice Address - Street 1:31 ELIZABETH ST
Practice Address - Street 2:UNIT 102
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2965
Practice Address - Country:US
Practice Address - Phone:774-239-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS78193757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst