Provider Demographics
NPI:1710613070
Name:PALMER, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 INTERLOCKEN BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8105
Mailing Address - Country:US
Mailing Address - Phone:703-438-7346
Mailing Address - Fax:
Practice Address - Street 1:295 INTERLOCKEN BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8105
Practice Address - Country:US
Practice Address - Phone:703-438-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009924142104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker