Provider Demographics
NPI:1407150501
Name:PALMER, SHARON ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANNE
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:ANNE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1428 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4147
Mailing Address - Country:US
Mailing Address - Phone:631-665-1900
Mailing Address - Fax:631-665-1377
Practice Address - Street 1:1428 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4147
Practice Address - Country:US
Practice Address - Phone:631-665-1900
Practice Address - Fax:631-665-1377
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0828531041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool