MEDICARE: THE COMMUNITY CHARTER SCHOOL OF PATERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YS0200X	School Counselor
2	103K00000X	Behavior Analyst
3	103TC1900X	Counseling Psychologist
4	103TS0200X	School Psychologist
5	1041C0700X	Clinical Social Worker
6	1041S0200X	School Social Worker
7	163WS0200X	School Registered Nurse
8	2251P0200X	Pediatric Physical Therapist
9	225XP0200X	Pediatric Occupational Therapist
10	235Z00000X	Speech-Language Pathologist
11	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1881257558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMMUNITY CHARTER SCHOOL OF PATERSON

Provider Business Mailing Address
First Line	:	75 SPRUCE ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07501-1720
Country	:	US
Telephone Number	:	973-413-2057
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 SPRUCE ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07501-1720
Country	:	US
Telephone Number	:	973-413-2057
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISOR FOR STUDENT SUPPORT SERV
Name	:	TINA VOLPE
Credential	:
Telephone Number	:	973-413-2057

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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Directions to “THE COMMUNITY CHARTER SCHOOL OF PATERSON ” Practice Location

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