Provider Demographics
NPI:1962535328
Name:SPATOLA, SCOTT S (MA LCADC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:SPATOLA
Suffix:
Gender:M
Credentials:MA LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 POWERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 POWERVILLE ROAD
Practice Address - Street 2:SAINT CLARES HOSPITAL
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005
Practice Address - Country:US
Practice Address - Phone:973-299-5475
Practice Address - Fax:973-299-5425
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00072000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138601Medicaid
NJ310050Medicare ID - Type Unspecified