Provider Demographics
NPI:1972686178
Name:PALKEN TERVO, JANICE DIANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:DIANNE
Last Name:PALKEN TERVO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1710
Mailing Address - Country:US
Mailing Address - Phone:978-952-2578
Mailing Address - Fax:978-486-0354
Practice Address - Street 1:52 CEDAR ST
Practice Address - Street 2:PSYCHIATRY AND FAMILY COUNSELING
Practice Address - City:WOCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609
Practice Address - Country:US
Practice Address - Phone:508-752-5191
Practice Address - Fax:508-792-1514
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05648Medicare ID - Type Unspecified