Provider Demographics
NPI:1801566997
Name:PALMOR, MATAHN DAVID (LMSW)
Entity type:Individual
Prefix:
First Name:MATAHN
Middle Name:DAVID
Last Name:PALMOR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:POLLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1127 DICKENS ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6619 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-6122
Practice Address - Country:US
Practice Address - Phone:718-851-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102906104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty