Healthcare Provider Details

I. General information

NPI: 1366715591
Provider Name (Legal Business Name): LARISA M. PALMER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2012
Last Update Date: 02/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S FEDERAL HWY STE 302
HOLLYWOOD FL
33020-6811
US

IV. Provider business mailing address

210 S FEDERAL HWY STE 302
HOLLYWOOD FL
33020-6811
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax: 954-925-3193
Mailing address:
  • Phone: 954-925-3191
  • Fax: 954-925-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: