Provider Demographics
NPI:1255341533
Name:PALMER, BRUCE EDMUND (LPCMH)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDMUND
Last Name:PALMER
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 CLEARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2502
Mailing Address - Country:US
Mailing Address - Phone:302-571-8845
Mailing Address - Fax:302-571-8841
Practice Address - Street 1:1200 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4313
Practice Address - Country:US
Practice Address - Phone:302-571-8845
Practice Address - Fax:301-571-8841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health