Healthcare Provider Details

I. General information

NPI: 1063027381
Provider Name (Legal Business Name): SUSANNA PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 POPLAR ST
CAMBRIDGE MD
21613-1834
US

IV. Provider business mailing address

514 POPLAR ST
CAMBRIDGE MD
21613-1834
US

V. Phone/Fax

Practice location:
  • Phone: 800-867-2395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31541
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: