MEDICARE: LAURA BUSCEMI

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	101YM0800X	Mental Health Counselor	37PC00573100	NJ

General Provider Information

NPI Number	:	1780012336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BUSCEMI

Provider Business Mailing Address
First Line	:	10 PEACHTREE CT
Second Line	:
City	:	MULLICA HILL
State	:	NJ
Zip	:	08062-9459
Country	:	US
Telephone Number	:	856-381-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 MOUNT VERNON AVE
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2034
Country	:	US
Telephone Number	:	856-381-9616
Fax Number	:

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

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	09/15/2021

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