Provider Demographics
NPI:1669753364
Name:PALMER, LEE FOX (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:LEE
Middle Name:FOX
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 ROUTE 488
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9308
Mailing Address - Country:US
Mailing Address - Phone:315-548-6631
Mailing Address - Fax:
Practice Address - Street 1:1550 ROUTE 488
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9308
Practice Address - Country:US
Practice Address - Phone:315-548-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-053825-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR053825-1OtherSOCIAL WORK LICENSE