Provider Demographics
NPI:1841492162
Name:PALMER, KAREN PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:PATRICIA
Last Name:PALMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23016 LAKE FOREST DR
Mailing Address - Street 2:423
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1324
Mailing Address - Country:US
Mailing Address - Phone:949-855-2733
Mailing Address - Fax:714-435-8051
Practice Address - Street 1:2488 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5196
Practice Address - Country:US
Practice Address - Phone:949-855-2733
Practice Address - Fax:714-435-8043
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY13770OtherCLINICAL PSYCHOLOGIST