Provider Demographics
NPI:1104942937
Name:PALOMBO, CAMILLE ROSE (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:ROSE
Last Name:PALOMBO
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 GRAVELLY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8465
Mailing Address - Country:US
Mailing Address - Phone:609-654-4825
Mailing Address - Fax:609-654-6218
Practice Address - Street 1:901 OLD MARLTON PIKE W
Practice Address - Street 2:EXECUTIVE BLD
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2080
Practice Address - Country:US
Practice Address - Phone:609-953-4769
Practice Address - Fax:609-654-6218
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC01133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional