MEDICARE: MR. NICHOLAS M PALMIERI LCADC, CCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	4126	MD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCA059	MD

General Provider Information

NPI Number	:	1205851045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS M PALMIERI LCADC, CCDC

Provider Business Mailing Address
First Line	:	250 ENGLAR RD STE 3
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-2927
Country	:	US
Telephone Number	:	410-615-3469
Fax Number	:	800-251-0179

Provider Business Practice Location Address
First Line	:	250 ENGLAR RD STE 3
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-2927
Country	:	US
Telephone Number	:	410-615-3469
Fax Number	:	800-251-0179

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	02/24/2020

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