1730241407 NPI number — JOELLE PALMER

Table of content: JOELLE PALMER (NPI 1730241407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730241407 NPI number — JOELLE PALMER

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN LENT
Provider Other First Name:
JOELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY. D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730241407
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 2137
Provider Second Line Business Mailing Address:
73 RIVERVIEW CT.
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05468-2137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-527-5360
Provider Business Mailing Address Fax Number:
802-658-0216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05403-6432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-658-3924
Provider Business Practice Location Address Fax Number:
802-658-0216
Provider Enumeration Date:
12/15/2006

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: 103TC2200X , with the licence number:  047-0000768 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OVN2358 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00049612 . This is a "BC BS PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2051017 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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