=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154679595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM PALMER LCSW, BCD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2012
-----------------------------------------------------
Last Update Date | 10/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 NATOMA ST SUITE 110
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-2658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-850-0292
-----------------------------------------------------
Fax | 916-281-3951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 NATOMA ST SUITE 110
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-2658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-850-0292
-----------------------------------------------------
Fax | 916-281-3951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 20134
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------