Provider Demographics
NPI:1285322917
Name:PALMER, BRYAN JAMES (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JAMES
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 CLEARY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-4113
Mailing Address - Country:US
Mailing Address - Phone:315-580-0449
Mailing Address - Fax:
Practice Address - Street 1:3957 CLEARY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-4113
Practice Address - Country:US
Practice Address - Phone:315-580-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0804831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty