Provider Demographics
NPI:1043036734
Name:PALMER, MICHELLE L (PSYS,NCSP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:PALMER
Suffix:
Gender:F
Credentials:PSYS,NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13130 DAIRYMAID DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2311
Mailing Address - Country:US
Mailing Address - Phone:301-646-9994
Mailing Address - Fax:
Practice Address - Street 1:850 HUNGERFORD DR RM 50
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1718
Practice Address - Country:US
Practice Address - Phone:240-740-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-62693-R9V5G4103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty