Provider Demographics
NPI:1245596436
Name:PALMEN, JESSICA N (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:PALMEN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LGSW
Mailing Address - Street 1:8614 OCEAN GTWY
Mailing Address - Street 2:# 4
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7217
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD202481041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD346646OtherTRICARE/MHN
MD609500300Medicaid
MD742LOtherMEDICARE PART B
MD7840093OtherAETNA
MDR968OtherCAREFIRST OF MARYLAND
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD609550002Medicaid