Basic Information
| Provider Information | |||||||||
| NPI: | 1073665410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALERMO | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 PINECREST DR UNIT 7 | ||||||||
| Address2: | |||||||||
| City: | ESSEX JUNCTION | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054522936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4246340234 | ||||||||
| FaxNumber: | 8028784404 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 PINECREST DR UNIT 7 | ||||||||
| Address2: | |||||||||
| City: | ESSEX JUNCTION | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054522936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4246340234 | ||||||||
| FaxNumber: | 8028784404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC1900X | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TM1800X | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC0700X | 048-0000917 | VT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1016742 | 05 | VT | MEDICAID |