MEDICARE: KAPRI NICOLE HEADLEY

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	37AC00839400	NJ

General Provider Information

NPI Number	:	1164816153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAPRI NICOLE HEADLEY

Provider Business Mailing Address
First Line	:	279 CLARK ST APT A11
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-1000
Country	:	US
Telephone Number	:	551-284-2958
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 VALLEY RD STE 150
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2709
Country	:	US
Telephone Number	:	973-375-1509
Fax Number	:

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

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	12/10/2025

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Directions to “ KAPRI NICOLE HEADLEY ” Practice Location

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