Provider Demographics
NPI:1255634127
Name:SCAMARONI, MARTIN SR (DD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:SCAMARONI
Suffix:SR
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000 PMB 10 MERCEDITA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-8000
Mailing Address - Country:US
Mailing Address - Phone:787-409-7030
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE ATOCHA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3209
Practice Address - Country:US
Practice Address - Phone:787-409-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAC-III-15-62-0034101YA0400X
PRTC-III-15-62-0041101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral