MEDICARE: NICOLE A SCAMPORINO 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	101YM0800X	Mental Health Counselor	37AC00773400	NJ

General Provider Information

NPI Number	:	1083467153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE A SCAMPORINO LAC

Provider Business Mailing Address
First Line	:	36 MOUNTAINWOOD CT
Second Line	:
City	:	TOTOWA
State	:	NJ
Zip	:	07512-2184
Country	:	US
Telephone Number	:	201-388-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 LACEY RD
Second Line	:
City	:	FORKED RIVER
State	:	NJ
Zip	:	08731-1063
Country	:	US
Telephone Number	:	609-312-3322
Fax Number	:

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/15/2024

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Directions to “ NICOLE A SCAMPORINO LAC” Practice Location

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