Provider Demographics
NPI:1366871204
Name:PALMENTERA, PAMELA R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:PALMENTERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 945
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2952
Mailing Address - Country:US
Mailing Address - Phone:312-695-9627
Mailing Address - Fax:312-695-6072
Practice Address - Street 1:676 N SAINT CLAIR ST STE 945
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2952
Practice Address - Country:US
Practice Address - Phone:312-695-9627
Practice Address - Fax:312-695-6072
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149006887261QM2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty