MEDICARE: RUTH D PALMQUIST LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	000022-1	NY

General Provider Information

NPI Number	:	1164625521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH D PALMQUIST LMHC

Provider Business Mailing Address
First Line	:	1744 DAVID DR
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-9731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 W STATE ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1858
Country	:	US
Telephone Number	:	716-790-8202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/18/2023

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