Provider Demographics
NPI:1730241407
Name:PALMER, JOELLE
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:
Other - Last Name:VAN LENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:PO BOX 2137
Mailing Address - Street 2:73 RIVERVIEW CT.
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-2137
Mailing Address - Country:US
Mailing Address - Phone:802-527-5360
Mailing Address - Fax:802-658-0216
Practice Address - Street 1:30 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:S BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6432
Practice Address - Country:US
Practice Address - Phone:802-658-3924
Practice Address - Fax:802-658-0216
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000768103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2358Medicaid
VT00049612OtherBC BS PROVIDER NUMBER
VT2051017OtherCIGNA PROVIDER NUMBER
VTMAVN1732Medicare ID - Type Unspecified