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General NPI Number Information
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NPI Number | 1285062778
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Entity Type | Organization
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Legal Business Name | REYNALDO TOMAS PALACIO
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 3302 TILDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1412
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Country | US
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Telephone | 215-913-0870
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Fax | 215-703-5367
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Provider Business Mailing Address
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Address Line | 3302 TILDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1412
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Country | US
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Telephone | 215-913-0870
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Fax | 215-703-5367
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Authorized Official
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Title or Position | CLINICAL/BEHAVIAL-PSYCHOTHERAPIST
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Name | MR. REYNALDO TOMAS PALACIO
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Credential | LCSW,CCBT
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Telephone | 215-913-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW014360
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License Number State | PA
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