Healthcare Provider Details

I. General information

NPI: 1881650216
Provider Name (Legal Business Name): JESSICA L PALMIERI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 137
TOWANDA PA
18848-9730
US

IV. Provider business mailing address

RR 1 BOX 137
TOWANDA PA
18848-9730
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-0100
  • Fax: 570-268-2756
Mailing address:
  • Phone: 570-265-0100
  • Fax: 570-268-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW127647
License Number StatePA

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: