Provider Demographics
NPI:1588288187
Name:PALMER, DONALD JAY (PHD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JAY
Last Name:PALMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17601 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2124
Mailing Address - Country:US
Mailing Address - Phone:240-447-0399
Mailing Address - Fax:
Practice Address - Street 1:17601 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2124
Practice Address - Country:US
Practice Address - Phone:240-447-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01345103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist