Provider Demographics
NPI:1023344827
Name:DIPALMA, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DIPALMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1413
Mailing Address - Country:US
Mailing Address - Phone:703-400-7037
Mailing Address - Fax:
Practice Address - Street 1:50 E KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1413
Practice Address - Country:US
Practice Address - Phone:703-400-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00621100OtherNEW JERSEY DIVISION OFF CONSUMER AFFAIRS SPEECH LANGUAGEPATHOLOGIST