Provider Demographics
NPI:1376248856
Name:PALMER, EMILY (MA, EDS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7629 GIRARD AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4402
Mailing Address - Country:US
Mailing Address - Phone:810-449-7683
Mailing Address - Fax:
Practice Address - Street 1:3434 MIDWAY DR STE 2006
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4925
Practice Address - Country:US
Practice Address - Phone:619-255-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-23-265819106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician