MEDICARE: MRS. VANESSA NOELLE MARULLO M.A., LAC

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	101Y00000X	Counselor	37AC00333100	NJ

General Provider Information

NPI Number	:	1598239923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA NOELLE MARULLO M.A., LAC

Provider Business Mailing Address
First Line	:	296 MOUNTAIN WAY
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2817
Country	:	US
Telephone Number	:	201-407-9951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 VALLEY RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2073
Country	:	US
Telephone Number	:	973-368-7781
Fax Number	:

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

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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