Provider Demographics
NPI:1265585624
Name:DEBLASSIE, PAUL A III (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:DEBLASSIE
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2201 SAN PEDRO DR NE
Mailing Address - Street 2:SUITE 228 BLDG. 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4133
Mailing Address - Country:US
Mailing Address - Phone:505-884-2292
Mailing Address - Fax:
Practice Address - Street 1:2201 SAN PEDRO DR NE
Practice Address - Street 2:SUITE 228 BLDG. 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4133
Practice Address - Country:US
Practice Address - Phone:505-884-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical