Provider Demographics
NPI:1053328799
Name:PALMER, ELIZABETH RYAN (LCSW, AP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RYAN
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MARY ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2694
Mailing Address - Country:US
Mailing Address - Phone:407-621-1611
Mailing Address - Fax:
Practice Address - Street 1:442 N DILLARD ST STE 2
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2818
Practice Address - Country:US
Practice Address - Phone:407-654-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3800171100000X
FLSW70641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765197000Medicaid