Provider Demographics
NPI:1053572487
Name:PALMER, JOHN MALCOLM (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MALCOLM
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 JEFFERSON STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701
Mailing Address - Country:US
Mailing Address - Phone:845-791-8800
Mailing Address - Fax:845-791-7051
Practice Address - Street 1:64 JEFFERSON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-791-8800
Practice Address - Fax:845-791-7051
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0750261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical