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NPI Code Detail

MEDICARE: DR. PAUL S PALKO PSY.D,LCSW05

MEDICARE: DR. PAUL S PALKO PSY.D,LCSW05
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
11041C0700XClinical Social WorkerLCS16141CA

General Provider Information

NPI Number : 1619920824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL S PALKO PSY.D,LCSW05
Provider Business Mailing Address
First Line : 2400 WASHINGTON AVE
Second Line :
City : REDDING
State : CA
Zip : 96001-2832
Country : US
Telephone Number : 530-241-0552
Fax Number : 530-247-3354
Provider Business Practice Location Address
First Line : 2400 WASHINGTON AVE
Second Line :
City : REDDING
State : CA
Zip : 96001-2832
Country : US
Telephone Number : 530-241-0552
Fax Number : 530-247-3354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 07/08/2007

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