Provider Demographics
NPI:1023431673
Name:DEPALMA, JOHANNA
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:DEPALMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:DEPALMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8205 SPAIN RD NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3179
Mailing Address - Country:US
Mailing Address - Phone:505-856-0300
Mailing Address - Fax:505-856-7946
Practice Address - Street 1:8600 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1107
Practice Address - Country:US
Practice Address - Phone:505-821-3628
Practice Address - Fax:505-821-3628
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0166611101YM0800X
NMT-0163671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health