Healthcare Provider Details

I. General information

NPI: 1477988871
Provider Name (Legal Business Name): NICOLE PALAGANO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 FRISCH CT SUITE 305
PARAMUS NJ
07652-5248
US

IV. Provider business mailing address

210 MAPLEWOOD AVE
BOGOTA NJ
07603-1714
US

V. Phone/Fax

Practice location:
  • Phone: 201-805-1602
  • Fax:
Mailing address:
  • Phone: 201-805-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00452000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: