Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103G00000X | Clinical Psychologist | NA | IL |
N | 103TC0700X | Clinical Psychologist | NA | IL |
N | 103TH0100X | Health Service |
NPI | 1164047965 |
---|---|
Provider Name | Stephanie Palacios |
First Address | Cambridge, MA 02139-1099 |
Second Address | Cambridge, MA 02139-1099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2020 |
Last Update Date | 08/06/2020 |