Provider Demographics
NPI:1467544247
Name:DEBALDO, JOSEPH (MED)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DEBALDO
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 N. CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-631-7135
Mailing Address - Fax:
Practice Address - Street 1:11707 N. CLUB DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-631-7135
Practice Address - Fax:813-631-7128
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)