Healthcare Provider Details

I. General information

NPI: 1093692204
Provider Name (Legal Business Name): ROMAN PALITSKY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EXECUTIVE PARK DR NE
ATLANTA GA
30329-2206
US

IV. Provider business mailing address

1440 CLIFTON RD NE
ATLANTA GA
30322-1053
US

V. Phone/Fax

Practice location:
  • Phone: 646-667-8250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: