Provider Demographics
NPI:1174181291
Name:PALMER, LAURA LEIGH (MED, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEIGH
Last Name:PALMER
Suffix:
Gender:F
Credentials:MED, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6016
Mailing Address - Country:US
Mailing Address - Phone:650-888-9758
Mailing Address - Fax:
Practice Address - Street 1:2048 STERLING AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6016
Practice Address - Country:US
Practice Address - Phone:650-888-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical