Basic Information
Provider Information
NPI: 1699220996
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PALMER
FirstName: SHERRY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 96 SOUTH ST
Address2:  
City: WARE
State: MA
PostalCode: 010821616
CountryCode: US
TelephoneNumber: 4139676241
FaxNumber: 4137327075
Practice Location
Address1: 96 SOUTH ST
Address2:  
City: WARE
State: MA
PostalCode: 010821616
CountryCode: US
TelephoneNumber: 4139676241
FaxNumber: 4137327075
Other Information
ProviderEnumerationDate: 08/17/2016
LastUpdateDate: 08/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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