Individual provider Active NPI

David John Palmer, LCSW

  • Clinical Social Worker
  • Chino Hills, CA
National Provider Identifier
1053489567
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS20198 Issued in CA
Practice address
1907 Boys Republic Dr
Chino Hills, CA 91709-5447
Phone
(909) 628-1217
Fax
(909) 993-1106
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS20198 CA Primary

Addresses

Primary practice location

1907 Boys Republic Dr
Chino Hills, CA 91709-5447

Mailing address

1907 Boys Republic Drive
Chino Hills, CA 91709
Phone (909) 628-1217

Other practice location 1

9090 19th St
Rancho Cucamonga, CA 91701-4614
Phone (909) 945-5001 ext. 232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LCS20198CAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1053489567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 BOYS REPUBLIC DRIVE",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "91709",
            "telephone_number": "909-628-1217",
            "fax_number": "909-993-1106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 BOYS REPUBLIC DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095447",
            "telephone_number": "909-628-1217",
            "fax_number": "909-993-1106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9090 19th St",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917014614",
            "country_code": "US",
            "telephone_number": "909-945-5001 x232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMER",
        "first_name": "DAVID",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS20198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.