Provider Demographics
NPI:1851004188
Name:DEPALMA, P JON
Entity Type:Individual
Prefix:MR
First Name:P
Middle Name:JON
Last Name:DEPALMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9459
Mailing Address - Country:US
Mailing Address - Phone:719-332-9624
Mailing Address - Fax:
Practice Address - Street 1:126 GENERAL CHENNAULT ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2515
Practice Address - Country:US
Practice Address - Phone:383-350-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health