Provider Demographics
NPI:1730690546
Name:PALMA, JOHN T (PMHNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:PALMA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PRINZ CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2971
Mailing Address - Country:US
Mailing Address - Phone:631-323-0349
Mailing Address - Fax:
Practice Address - Street 1:2969 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2556
Practice Address - Country:US
Practice Address - Phone:203-691-7634
Practice Address - Fax:203-859-5437
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health