Provider Demographics
NPI:1023432812
Name:PALMER, JENNIFER (MFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6994 EL CAMINO REAL STE 205B
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4153
Mailing Address - Country:US
Mailing Address - Phone:760-383-1874
Mailing Address - Fax:
Practice Address - Street 1:6994 EL CAMINO REAL STE 205B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4153
Practice Address - Country:US
Practice Address - Phone:760-383-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105025106H00000X
CA505025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty