=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376066787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOEL C AMOROSO ASW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2017
-----------------------------------------------------
Last Update Date | 07/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 921 S 1ST ST # B
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95110-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-590-4605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 UNION AVE APT 255B
-----------------------------------------------------
City | CAMPBELL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95008-4265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-754-5416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 72670
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------