Provider Demographics
NPI:1215056098
Name:PERALTO, JAMES (MSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PERALTO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0324
Mailing Address - Country:US
Mailing Address - Phone:505-464-1573
Mailing Address - Fax:
Practice Address - Street 1:406 GAYTON RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0324
Practice Address - Country:US
Practice Address - Phone:505-464-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-12-21
Deactivation Date:2019-04-29
Deactivation Code:
Reactivation Date:2020-12-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)