1245394147 NPI number — SCOTT J CIPOLLA LMHC, LICSW

Table of content: SCOTT J CIPOLLA LMHC, LICSW (NPI 1245394147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245394147 NPI number — SCOTT J CIPOLLA LMHC, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIPOLLA
Provider First Name:
SCOTT
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245394147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 WATER ST
Provider Second Line Business Mailing Address:
SUITE #246
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-2889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-376-8451
Provider Business Mailing Address Fax Number:
978-462-9455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 WATER ST
Provider Second Line Business Practice Location Address:
SUITE #246
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-2889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-376-8451
Provider Business Practice Location Address Fax Number:
978-462-9455
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3881 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 111706 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1859706 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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