Provider Demographics
NPI:1023241502
Name:PALMIOTTO, JENNIFER (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:PALMIOTTO
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1147
Mailing Address - Country:US
Mailing Address - Phone:619-301-3452
Mailing Address - Fax:619-224-9508
Practice Address - Street 1:2907 SHELTER ISLAND DR
Practice Address - Street 2:SUITE 216
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2743
Practice Address - Country:US
Practice Address - Phone:619-301-3452
Practice Address - Fax:619-224-9508
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47573171M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator