Provider Demographics
NPI:1992065700
Name:PALMER, DIANA MARIE LAYOUS (LMFT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE LAYOUS
Last Name:PALMER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2608
Mailing Address - Country:US
Mailing Address - Phone:310-913-5775
Mailing Address - Fax:518-615-1202
Practice Address - Street 1:499 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2205
Practice Address - Country:US
Practice Address - Phone:310-913-5775
Practice Address - Fax:518-615-1202
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001210106H00000X
CAIMF77812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist