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General NPI Number Information
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NPI Number | 1255634127
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Entity Type | Individual
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Provider Name | MARTIN SCAMARONI SR. D.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 120 CALLE ATOCHA
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City | PONCE
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State | PR
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Zip | 00730-3209
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Country | US
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Telephone | 787-409-7030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2000 PMB 10 MERCEDITA
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City | PONCE
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State | PR
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Zip | 00717-8000
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Country | US
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Telephone | 787-409-7030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AC-III-15-62-0034
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | TC-III-15-62-0041
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License Number State | PR
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