Healthcare Provider Details

I. General information

NPI: 1972440808
Provider Name (Legal Business Name): JAMESON DEPAOLA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 CHIQUITA BLVD S STE 204
CAPE CORAL FL
33914-4267
US

IV. Provider business mailing address

1089 WINDING PINES CIR UNIT 205
CAPE CORAL FL
33909-8759
US

V. Phone/Fax

Practice location:
  • Phone: 941-451-7506
  • Fax:
Mailing address:
  • Phone: 239-900-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: