MEDICARE: MS. NANCY ELLEN MAURIELLO MA,LPC

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	101YP2500X	Professional Counselor	37PC00540300	NJ

General Provider Information

NPI Number	:	1275993396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY ELLEN MAURIELLO MA,LPC

Provider Business Mailing Address
First Line	:	28 BOWLING GREEN PKWY STE LL3
Second Line	:
City	:	LAKE HOPATCONG
State	:	NJ
Zip	:	07849-2445
Country	:	US
Telephone Number	:	862-243-5241
Fax Number	:	973-288-1028

Provider Business Practice Location Address
First Line	:	28 BOWLING GREEN PKWY STE LL3
Second Line	:
City	:	LAKE HOPATCONG
State	:	NJ
Zip	:	07849-2445
Country	:	US
Telephone Number	:	862-243-5241
Fax Number	:	973-288-1028

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	04/19/2018

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