MEDICARE: MICHAEL DAVID PALMERTREE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT 7209	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFT7209	OTHER	CA	MFT LICENCE

General Provider Information

NPI Number	:	1114130986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID PALMERTREE LMFT

Provider Business Mailing Address
First Line	:	117 22ND AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1216
Country	:	US
Telephone Number	:	415-309-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	3527 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1884
Country	:	US
Telephone Number	:	415-309-4106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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