Healthcare Provider Details

I. General information

NPI: 1497180327
Provider Name (Legal Business Name): LORI-ANN PALAZZO MHC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 BOSTON RD
BRONX NY
10462-1201
US

IV. Provider business mailing address

3188 WATERBURY AVE
BRONX NY
10465-1440
US

V. Phone/Fax

Practice location:
  • Phone: 718-892-0002
  • Fax: 646-403-3699
Mailing address:
  • Phone: 718-892-0002
  • Fax: 646-403-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005091
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005091
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005091
License Number StateNY

VIII. Authorized Official

Name: LORI-ANN PALAZZO
Title or Position: OWNER
Credential: LMHC
Phone: 718-892-0002