Provider Demographics
NPI:1417914904
Name:PALMER, AMY (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 BOSTON POST RD
Mailing Address - Street 2:SUITE 23A
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1368
Mailing Address - Country:US
Mailing Address - Phone:203-533-5858
Mailing Address - Fax:
Practice Address - Street 1:2488 BOSTON POST RD
Practice Address - Street 2:SUITE 23A
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1368
Practice Address - Country:US
Practice Address - Phone:203-533-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002416103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002416CT01OtherANTHEM BLUE CROSS AND BLU
CT004224325Medicaid
CT004224325Medicaid
CTP0023034Medicare PIN