Provider Demographics
NPI:1154437663
Name:PALMER, GREGORY K (MSW LCSW BCD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:PALMER
Suffix:
Gender:M
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N 17TH STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5014
Mailing Address - Country:US
Mailing Address - Phone:610-820-3900
Mailing Address - Fax:610-820-3835
Practice Address - Street 1:401 N 17TH STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5014
Practice Address - Country:US
Practice Address - Phone:610-820-3900
Practice Address - Fax:610-820-3835
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CW001017L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
134196000OtherMAGELLAN
P2655009OtherOXFORD
PA01978002OtherCAPITAL BLUE CROSS
PA621326OtherHIGHMARK BLUE SHIELD
134196000OtherMAGELLAN
621326G6XMedicare ID - Type Unspecified