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General NPI Number Information
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NPI Number | 1902254394
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Entity Type | Individual
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Provider Name | MIRIAM PALMER
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 1266 14TH ST
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City | OAKLAND
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State | CA
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Zip | 94607-2205
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Country | US
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Telephone | 408-207-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 SAND CREEK ROAD C-1, #372
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City | BRENTWOOD
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State | CA
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Zip | 94513
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Country | US
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Telephone | 408-207-3138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | IMF99876
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT139196
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License Number State | CA
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