Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35S100211800 | NJ |
Y | 103T00000X | Psychologist | 35S100211800 | NJ |
NPI | 1013032689 |
---|---|
Provider Name | Jane Palumbo Lastella |
First Address | Closter, NJ 07624-1634 |
Second Address | Haworth, NJ 07641-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |