Provider Demographics
NPI:1982752663
Name:PALM, LAURA K (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:PALM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD BUILDING 5 STE 69
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1668
Mailing Address - Country:US
Mailing Address - Phone:732-344-0736
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD BUILDING 5 STE 69
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1668
Practice Address - Country:US
Practice Address - Phone:732-344-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052258001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCP701378Medicare ID - Type Unspecified