Healthcare Provider Details

I. General information

NPI: 1871004754
Provider Name (Legal Business Name): PALO RECOVERY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 05/30/2023
Certification Date: 04/04/2023
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: 401-484-0407
Mailing address:
  • Phone: 401-793-1468
  • Fax: 401-484-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PALO
Title or Position: OWNER
Credential: MA LCDP
Phone: 401-484-0407