Healthcare Provider Details

I. General information

NPI: 1407285893
Provider Name (Legal Business Name): JESSE C PALERMO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W ONONDAGA ST SUITE 10
SYRACUSE NY
13202-1888
US

IV. Provider business mailing address

375 W ONONDAGA ST SUITE 10
SYRACUSE NY
13202-1888
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-2030
  • Fax:
Mailing address:
  • Phone: 315-478-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05878800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: