Healthcare Provider Details

I. General information

NPI: 1881858124
Provider Name (Legal Business Name): ALTHEA PALMISANO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

3211 OPAL CT
WILMINGTON DE
19810-2254
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax:
Mailing address:
  • Phone: 302-477-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW124657
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8304
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: