Healthcare Provider Details

I. General information

NPI: 1023932936
Provider Name (Legal Business Name): ADRIE PALM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADRIE CRESEL PALM

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8408 WATT AVE
ANTELOPE CA
95843-9116
US

IV. Provider business mailing address

8408 WATT AVE
ANTELOPE CA
95843-9116
US

V. Phone/Fax

Practice location:
  • Phone: 916-338-6343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240169190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: