Provider Demographics
NPI:1144483157
Name:PALACIO, PATRICIA ANDREA (LMHC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANDREA
Last Name:PALACIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3087 34TH ST
Mailing Address - Street 2:2R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-5166
Mailing Address - Country:US
Mailing Address - Phone:646-346-0586
Mailing Address - Fax:
Practice Address - Street 1:11045 71ST RD
Practice Address - Street 2:1G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4960
Practice Address - Country:US
Practice Address - Phone:646-346-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health