MEDICARE: NICHOLAS JOSEPH SPANOLA 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	106H00000X	Marriage & Family Therapist	37PC00937900	NJ

General Provider Information

NPI Number	:	1194325019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JOSEPH SPANOLA LAC

Provider Business Mailing Address
First Line	:	345 16TH AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1667
Country	:	US
Telephone Number	:	848-333-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 HAWTHORNE AVE STE 1
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-2539
Country	:	US
Telephone Number	:	732-475-0843
Fax Number	:

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

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	03/25/2023

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