MEDICARE: MS. JENNIFER PALMIOTTO M.A., MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	47573	CA
2	174400000X	Specialist	47573	CA

General Provider Information

NPI Number	:	1023241502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER PALMIOTTO M.A., MFT

Provider Business Mailing Address
First Line	:	3405 WISTERIA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-1147
Country	:	US
Telephone Number	:	619-301-3452
Fax Number	:	619-224-9508

Provider Business Practice Location Address
First Line	:	2907 SHELTER ISLAND DR
Second Line	:	SUITE 216
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2743
Country	:	US
Telephone Number	:	619-301-3452
Fax Number	:	619-224-9508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	01/04/2011

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