MEDICARE: PALMO PSYCHOLOGY SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1104645456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMO PSYCHOLOGY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	101 LANG BLVD STE 1
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-1601
Country	:	US
Telephone Number	:	716-453-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LANG BLVD STE 1
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-1601
Country	:	US
Telephone Number	:	716-830-5787
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TRACY KLAPP
Credential	:
Telephone Number	:	716-453-0242

Provider Enumeration Date	:	10/04/2024
Last Update Date	:	11/29/2024

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