Provider Demographics
NPI:1104636463
Name:PALERMO, AMY KARLENE (MA, PLMHP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KARLENE
Last Name:PALERMO
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KARLENE
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4815 S 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1904
Mailing Address - Country:US
Mailing Address - Phone:402-915-0983
Mailing Address - Fax:
Practice Address - Street 1:4815 S 107TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1904
Practice Address - Country:US
Practice Address - Phone:402-915-0983
Practice Address - Fax:402-881-8668
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health