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NPI Code Detail

MEDICARE: MR. NICHOLAS JOEL PETRUCELLI CAC III

MEDICARE: MR. NICHOLAS JOEL PETRUCELLI CAC III
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
1101YA0400XAddiction (Substance Use Disorder) Counselor6919CO

General Provider Information

NPI Number : 1538461124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICHOLAS JOEL PETRUCELLI CAC III
Provider Business Mailing Address
First Line : 7251 E 49TH AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-4714
Country : US
Telephone Number : 303-468-6191
Fax Number : 303-321-3556
Provider Business Practice Location Address
First Line : 7251 E 49TH AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-4714
Country : US
Telephone Number : 303-468-6191
Fax Number : 303-321-3556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2010
Last Update Date : 01/13/2014

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