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NPI Code Detail

MEDICARE: MR. DERYL W PALMER LISW

MEDICARE: MR. DERYL W PALMER LISW
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
11041S0200XSchool Social WorkerM05423NM
21041C0700XClinical Social WorkerI-06859NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740317015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DERYL W PALMER LISW
Provider Business Mailing Address
First Line : PO BOX 6824
Second Line :
City : LAS CRUCES
State : NM
Zip : 88006-6824
Country : US
Telephone Number : 575-523-2288
Fax Number : 575-523-2299
Provider Business Practice Location Address
First Line : 2000 E LOHMAN AVE STE C
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3100
Country : US
Telephone Number : 575-523-2288
Fax Number : 575-523-2299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 06/30/2011

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Directions to “ MR. DERYL W PALMER LISW” Practice Location

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