Provider Demographics
NPI:1942511134
Name:PALMER, LAURI GAIL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LAURI
Middle Name:GAIL
Last Name:PALMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 W MAPLEHURST ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1294
Mailing Address - Country:US
Mailing Address - Phone:248-541-0937
Mailing Address - Fax:
Practice Address - Street 1:301 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2546
Practice Address - Country:US
Practice Address - Phone:248-854-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010345491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical