Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | AC-III-15-62-0034 | PR |
N | 101YP1600X | Pastoral Counselor | TC-III-15-62-0041 | PR |
NPI | 1255634127 |
---|---|
Provider Name | Dr. Martin Scamaroni SR. |
First Address | Ponce, PR 00717-8000 |
Second Address | Ponce, PR 00730-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 14/12/2010 |