Provider Demographics
NPI:1831387885
Name:PALKO, MARY ANN CHRISTINE (LMHC, MED)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:CHRISTINE
Last Name:PALKO
Suffix:
Gender:F
Credentials:LMHC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 LAKESIDE DR
Mailing Address - Street 2:#2016
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-1000
Mailing Address - Country:US
Mailing Address - Phone:617-388-8614
Mailing Address - Fax:
Practice Address - Street 1:1245 LAKESIDE DR
Practice Address - Street 2:#2016
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-1000
Practice Address - Country:US
Practice Address - Phone:617-388-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALM5081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health