Provider Demographics
NPI:1225303969
Name:LARISA PALMER, PSY.D., P.A.
Entity Type:Organization
Organization Name:LARISA PALMER, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-925-3191
Mailing Address - Street 1:210 S FEDERAL HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-925-3191
Mailing Address - Fax:
Practice Address - Street 1:210 S FEDERAL HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6811
Practice Address - Country:US
Practice Address - Phone:954-925-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7753103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty