Provider Demographics
NPI:1962256925
Name:PALMER, MATTHEW LUKE STONE (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LUKE STONE
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 1:2815 E 3RD ST UNIT 1064
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5434
Mailing Address - Country:US
Mailing Address - Phone:812-419-2637
Mailing Address - Fax:812-694-3834
Practice Address - Street 1:1449 S MICHIGAN AVE # 1054
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2810
Practice Address - Country:US
Practice Address - Phone:312-292-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011307A1041C0700X
DEQ5-00001821041C0700X
WI12030-1231041C0700X
ID44619741041C0700X
VT089.0135999TELE1041C0700X
FLTPSW43901041C0700X
SCTLS969CP1041C0700X
IL1490285581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical