MEDICARE: JANIENNE PALMER

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	095687-01	NY

General Provider Information

NPI Number	:	1508419706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIENNE PALMER

Provider Business Mailing Address
First Line	:	108 ROCKWOOD PL
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-5028
Country	:	US
Telephone Number	:	201-675-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 WILLIAMSBRIDGE RD STE 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1605
Country	:	US
Telephone Number	:	201-675-8410
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/31/2023

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