Provider Demographics
NPI:1780769539
Name:PALMER, TA-TANISHA NICOLE (MS)
Entity type:Individual
Prefix:MRS
First Name:TA-TANISHA
Middle Name:NICOLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BRINTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1175
Mailing Address - Country:US
Mailing Address - Phone:716-881-2591
Mailing Address - Fax:
Practice Address - Street 1:86 BRINTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1175
Practice Address - Country:US
Practice Address - Phone:716-881-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered251B00000XAgenciesCase Management