Healthcare Provider Details

I. General information

NPI: 1285453878
Provider Name (Legal Business Name): MIRNA JEANETH SCARPULLA MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

IV. Provider business mailing address

118 MAYFAIR AVE
WEST HEMPSTEAD NY
11552-1514
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax:
Mailing address:
  • Phone: 516-840-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP119582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: