Healthcare Provider Details

I. General information

NPI: 1497274518
Provider Name (Legal Business Name): JENNIFER PALO MA LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 OPPER AVE
WARWICK RI
02889-2744
US

IV. Provider business mailing address

55 OPPER AVE
WARWICK RI
02889-2744
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-1468
  • Fax:
Mailing address:
  • Phone: 401-793-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00706
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: