Healthcare Provider Details

I. General information

NPI: 1639199003
Provider Name (Legal Business Name): GEORGE M KAPALKA PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 GULTON COURT NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

19 CAMINO ALTO
PLACITAS NM
87043
US

V. Phone/Fax

Practice location:
  • Phone: 732-206-1616
  • Fax:
Mailing address:
  • Phone: 505-553-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSI2835
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: