Healthcare Provider Details

I. General information

NPI: 1720766363
Provider Name (Legal Business Name): BROOKE CELESTE PALUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

986 S EAST ST APT B
AMHERST MA
01002-3018
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-1038
  • Fax:
Mailing address:
  • Phone: 267-804-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number229354
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: