Healthcare Provider Details

I. General information

NPI: 1972742013
Provider Name (Legal Business Name): LISA C PALMER PHD, LMFT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E PALMETTO PARK RD STE 206
BOCA RATON FL
33432-5081
US

IV. Provider business mailing address

499 E PALMETTO PARK RD STE 206
BOCA RATON FL
33432-5081
US

V. Phone/Fax

Practice location:
  • Phone: 954-907-3446
  • Fax:
Mailing address:
  • Phone: 954-907-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMT2224
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: