Provider Demographics
NPI:1346444379
Name:PALMER, VICKY (CADAC1292AD)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:CADAC1292AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 WASHINGTON ST
Mailing Address - Street 2:2A
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3640
Mailing Address - Country:US
Mailing Address - Phone:978-979-6429
Mailing Address - Fax:
Practice Address - Street 1:284 WASHINGTON ST
Practice Address - Street 2:2A
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3640
Practice Address - Country:US
Practice Address - Phone:978-979-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1292AD CADAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)