Provider Demographics
NPI:1205245651
Name:PALMER, BRYAN DOUGLAS (LCSW, MSSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DOUGLAS
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 20TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1408
Mailing Address - Country:US
Mailing Address - Phone:305-586-1173
Mailing Address - Fax:
Practice Address - Street 1:1410 20TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1444
Practice Address - Country:US
Practice Address - Phone:305-586-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL119811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical