MEDICARE: MR. MICHAEL L ZAMPELLA LCSW

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	1041C0700X	Clinical Social Worker	R045054-1	NY

General Provider Information

NPI Number	:	1275566499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL L ZAMPELLA LCSW

Provider Business Mailing Address
First Line	:	20 EDWARD AVE
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857-2102
Country	:	US
Telephone Number	:	201-401-2586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3622
Country	:	US
Telephone Number	:	201-401-2586
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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