Provider Demographics
NPI:1942348552
Name:PALMER, ADRIENNE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:R
Last Name:PALMER
Suffix:
Gender:F
Credentials: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 4011
Mailing Address - Street 2:
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-4011
Mailing Address - Country:US
Mailing Address - Phone:201-450-7741
Mailing Address - Fax:
Practice Address - Street 1:352 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2619
Practice Address - Country:US
Practice Address - Phone:973-365-2125
Practice Address - Fax:973-365-6152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014413001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7078519OtherAETNA PROVIDER ID NUMBER