Provider Demographics
NPI:1285453878
Name:SCARPULLA, MIRNA JEANETH (MHC-LP)
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:JEANETH
Last Name:SCARPULLA
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAYFAIR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1514
Mailing Address - Country:US
Mailing Address - Phone:516-840-7448
Mailing Address - Fax:
Practice Address - Street 1:113 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3438
Practice Address - Country:US
Practice Address - Phone:516-622-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP119582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health