MEDICARE: PHYLLIS PALMER MSW

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	101Y00000X	Counselor		FL
2	101Y00000X	Counselor		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710268651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS PALMER MSW

Provider Business Mailing Address
First Line	:	3615 VALLEYVIEW DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-2896
Country	:	US
Telephone Number	:	660-229-0449
Fax Number	:	407-261-0523

Provider Business Practice Location Address
First Line	:	668 N ORLANDO AVE STE 210
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4459
Country	:	US
Telephone Number	:	407-215-0095
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/07/2011

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Directions to “ PHYLLIS PALMER MSW” Practice Location

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