Provider Demographics
NPI:1922027986
Name:PALMER, GAYLON I (MSW/LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAYLON
Middle Name:I
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 1:8002 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-863-7096
Mailing Address - Fax:916-863-7098
Practice Address - Street 1:9718 FAIR OAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7037
Practice Address - Country:US
Practice Address - Phone:916-863-7096
Practice Address - Fax:916-863-7098
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW71781041C0700X
CA71781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922027986Medicare NSC