MEDICARE: MR. MATTHEW LUKE STONE PALMER LCSW

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	Q5-0000182	DE
2	1041C0700X	Clinical Social Worker	133788	IA
3	1041C0700X	Clinical Social Worker	089.0135999TELE	VT
4	1041C0700X	Clinical Social Worker	149028558	IL
5	1041C0700X	Clinical Social Worker	TLS969CP	SC
6	1041C0700X	Clinical Social Worker	34011307A	IN
7	1041C0700X	Clinical Social Worker	12030-123	WI
8	1041C0700X	Clinical Social Worker	4461974	ID
9	1041C0700X	Clinical Social Worker	TPSW4390	FL

General Provider Information

NPI Number	:	1962256925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW LUKE STONE PALMER LCSW

Provider Business Mailing Address
First Line	:	1228 QUIGLEY PL
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-4405
Country	:	US
Telephone Number	:	812-419-2637
Fax Number	:	812-694-3834

Provider Business Practice Location Address
First Line	:	1449 S MICHIGAN AVE # 1054
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2810
Country	:	US
Telephone Number	:	312-292-9818
Fax Number	:

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

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	12/10/2025

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