Provider Demographics
NPI:1730699711
Name:PALACIOS, MAILEN AYELEN (LMFT)
Entity type:Individual
Prefix:
First Name:MAILEN
Middle Name:AYELEN
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MAPLEWOOD AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2504
Mailing Address - Country:US
Mailing Address - Phone:484-354-9065
Mailing Address - Fax:
Practice Address - Street 1:135 COLUMBIA TPKE STE 303
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2189
Practice Address - Country:US
Practice Address - Phone:973-229-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00184000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist