Provider Demographics
NPI:1578807020
Name:PALMER, R DANIEL (PH,D,)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:DANIEL
Last Name:PALMER
Suffix:
Gender:M
Credentials:PH,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 MULBERRY ST
Mailing Address - Street 2:P.O. BOX 465
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1837
Mailing Address - Country:US
Mailing Address - Phone:814-696-9494
Mailing Address - Fax:
Practice Address - Street 1:518 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1837
Practice Address - Country:US
Practice Address - Phone:814-696-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004711L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical