MEDICARE: DORA MARIA PALMA LGSW

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	1041C0700X	Clinical Social Worker	32386	MN

General Provider Information

NPI Number	:	1285521674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORA MARIA PALMA LGSW

Provider Business Mailing Address
First Line	:	7124 TICONDEROGA TRL
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-3448
Country	:	US
Telephone Number	:	612-597-3978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 BLOOMINGTN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2817
Country	:	US
Telephone Number	:	612-417-4007
Fax Number	:

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

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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