Provider Demographics
NPI:1104691203
Name:PALMER, PATRICIA (MA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10017 SPANISH OAK CT
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5623
Mailing Address - Country:US
Mailing Address - Phone:408-242-5626
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL STE 216
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1458
Practice Address - Country:US
Practice Address - Phone:408-475-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12226101YM0800X
CA134842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health