Provider Demographics
NPI:1790286557
Name:PALAZZO-GUTIERREZ, MAXINE (CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:PALAZZO-GUTIERREZ
Suffix:
Gender:
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2719
Mailing Address - Country:US
Mailing Address - Phone:914-479-8263
Mailing Address - Fax:
Practice Address - Street 1:3961 HILLMAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3001
Practice Address - Country:US
Practice Address - Phone:718-796-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X, 106S00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician