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General NPI Number Information
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NPI Number | 1619208584
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Entity Type | Individual
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Provider Name | NICHOLAS A PALMISANO LADAC
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Gender | Male
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 37 PLAZA LA PRENSA
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City | SANTA FE
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State | NM
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Zip | 87507-9724
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Country | US
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Telephone | 505-257-8766
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Fax | 505-792-8983
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Provider Business Mailing Address
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Address Line | 37 PLAZA LA PRENSA
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City | SANTA FE
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State | NM
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Zip | 87507-9724
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Country | US
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Telephone | 505-257-8766
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Fax | 505-476-9272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAD0161441
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License Number State | NM
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