Provider Demographics
NPI:1285668657
Name:PALMER, LISA ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROSE
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-0744
Mailing Address - Country:US
Mailing Address - Phone:606-875-1130
Mailing Address - Fax:606-678-0603
Practice Address - Street 1:110 RICHIE LN
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6128
Practice Address - Country:US
Practice Address - Phone:606-875-1130
Practice Address - Fax:606-678-0603
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12381041C0700X
KY0859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYM400018445Medicare PIN