Provider Demographics
NPI:1710416417
Name:PALMORE, CARRIE CASCEAL (MSC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:CASCEAL
Last Name:PALMORE
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:CASCEAL
Other - Last Name:SWAGGARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JONES
Mailing Address - Street 1:127 N SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2412
Mailing Address - Country:US
Mailing Address - Phone:209-851-3455
Mailing Address - Fax:209-227-7255
Practice Address - Street 1:540 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2117
Practice Address - Country:US
Practice Address - Phone:209-851-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health