1154437663 NPI number — GREGORY K PALMER MSW LCSW BCD

Table of content: (NPI 1558673970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154437663 NPI number — GREGORY K PALMER MSW LCSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
GREGORY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW BCD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154437663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 N 17TH STREET
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-5014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-820-3900
Provider Business Mailing Address Fax Number:
610-820-3835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N 17TH STREET
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-5014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-820-3900
Provider Business Practice Location Address Fax Number:
610-820-3835
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  CW001017L ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 134196000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2655009 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01978002 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 621326 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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