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General NPI Number Information
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NPI Number | 1679827778
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Entity Type | Organization
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Legal Business Name | PALECEK,INC.
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 260 H AVE
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City | CORONADO
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State | CA
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Zip | 92118-1222
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Country | US
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Telephone | 619-519-2554
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Fax |
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Provider Business Mailing Address
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Address Line | 260 H AVE
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City | CORONADO
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State | CA
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Zip | 92118-1222
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Country | US
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Telephone | 619-519-2554
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLORY ANN PALECEK
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Credential | PHD
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Telephone | 619-519-2554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY7272
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PST7272
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY7272
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License Number State | CA
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