MEDICARE: MR. RONALD ANTHONY PALERMO TX LCDC, IC & RC,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12479	TX

General Provider Information

NPI Number	:	1669363404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD ANTHONY PALERMO TX LCDC, IC & RC,

Provider Business Mailing Address
First Line	:	4843 WESLEYAN ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1753
Country	:	US
Telephone Number	:	210-322-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	4843 WESLEYAN ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1753
Country	:	US
Telephone Number	:	210-322-1003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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