Provider Demographics
NPI:1316140700
Name:PALUMBO, MARY E (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:PALUMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:2438 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1840
Mailing Address - Country:US
Mailing Address - Phone:716-372-9344
Mailing Address - Fax:716-372-9497
Practice Address - Street 1:2438 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1840
Practice Address - Country:US
Practice Address - Phone:716-372-9344
Practice Address - Fax:716-372-9497
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051031-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6238Medicaid