=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205488038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P.A.L.M.S. PROVIDING ALTERNATIVE LINES OF MOVEMENT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2019
-----------------------------------------------------
Last Update Date | 09/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 SCENIC DR STE 2
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-702-1273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7251
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-7251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-337-9684
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ LICENSED CLINICIAN
-----------------------------------------------------
Name | MARYANNE GALLOWAY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 732-337-9684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------