1184644270 NPI number — MS. DEBORAH PALMER LICSW

Table of content: MS. DEBORAH PALMER LICSW (NPI 1184644270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184644270 NPI number — MS. DEBORAH PALMER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

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:
1184644270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 240, 245 RUSSELL STREET, SUITE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01035-0240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-584-0902
Provider Business Mailing Address Fax Number:
413-584-0903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 RUSSELL ST STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01035-9563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-584-0902
Provider Business Practice Location Address Fax Number:
413-584-0903
Provider Enumeration Date:
07/20/2006

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: 1041C0700X , with the licence number:  111857 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1854101 . This is a "MASSHEALTH QMB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P 08730 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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