Provider Demographics
NPI:1134468754
Name:PALMISANO, KENNETH (LCSW,LCADC,CCS,CPRS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:PALMISANO
Suffix:
Gender:M
Credentials:LCSW,LCADC,CCS,CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 ROUTE 57 W
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4411
Mailing Address - Country:US
Mailing Address - Phone:908-689-1000
Mailing Address - Fax:201-583-7112
Practice Address - Street 1:492 ROUTE 57 W
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4411
Practice Address - Country:US
Practice Address - Phone:908-689-1000
Practice Address - Fax:908-689-1491
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 175T00000X
NJ37CA00106300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No175T00000XOther Service ProvidersPeer Specialist