Healthcare Provider Details

I. General information

NPI: 1932358058
Provider Name (Legal Business Name): KATHERINE PALKO PSY.D., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HATCHETTS HILL RD
OLD LYME CT
06371-1534
US

IV. Provider business mailing address

5753 MIAMI LAKES DR E
MIAMI LAKES FL
33014-2417
US

V. Phone/Fax

Practice location:
  • Phone: 800-370-3651
  • Fax: 877-515-7147
Mailing address:
  • Phone: 305-403-0006
  • Fax: 305-403-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC 8233
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3758
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: