Provider Demographics
NPI:1649732181
Name:PALACIOS BROZ, DAISY
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:PALACIOS BROZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CENTER GROVE RD APT M-44
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4482
Mailing Address - Country:US
Mailing Address - Phone:305-282-0553
Mailing Address - Fax:
Practice Address - Street 1:2831 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4607
Practice Address - Country:US
Practice Address - Phone:202-462-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional