Provider Demographics
NPI:1528036126
Name:PALMER, DIANE S (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:PALMER
Suffix:
Gender:F
Credentials:MSW 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 276
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759
Mailing Address - Country:US
Mailing Address - Phone:732-350-7780
Mailing Address - Fax:732-833-1441
Practice Address - Street 1:85 SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-350-7780
Practice Address - Fax:732-833-1441
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NJ44SC00090800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
O99554Medicare UPIN