Healthcare Provider Details

I. General information

NPI: 1962378323
Provider Name (Legal Business Name): LOUIS A PALACIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 HILLSIDE AVE
JAMAICA NY
11432-5773
US

IV. Provider business mailing address

28 PHILLIPS WALK
WEST BABYLON NY
11704-7311
US

V. Phone/Fax

Practice location:
  • Phone: 718-558-7230
  • Fax:
Mailing address:
  • Phone: 718-558-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: