1104942937 NPI number — MS. CAMILLE ROSE PALOMBO M.ED, LPC

Table of content: MS. CAMILLE ROSE PALOMBO M.ED, LPC (NPI 1104942937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104942937 NPI number — MS. CAMILLE ROSE PALOMBO M.ED, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALOMBO
Provider First Name:
CAMILLE
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104942937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 GRAVELLY HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08055-8465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-654-4825
Provider Business Mailing Address Fax Number:
609-654-6218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 OLD MARLTON PIKE W
Provider Second Line Business Practice Location Address:
EXECUTIVE BLD
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-2080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-953-4769
Provider Business Practice Location Address Fax Number:
609-654-6218
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC01133 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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