Healthcare Provider Details

I. General information

NPI: 1063376390
Provider Name (Legal Business Name): DOUGLAS RAYMOND DEPALMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TECHNOLOGY WAY STE 320
LIBERTYVILLE IL
60048-5364
US

IV. Provider business mailing address

900 TECHNOLOGY WAY STE 320
LIBERTYVILLE IL
60048-5364
US

V. Phone/Fax

Practice location:
  • Phone: 847-680-2715
  • Fax: 847-680-3832
Mailing address:
  • Phone: 847-680-2715
  • Fax: 847-680-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150118558
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: