Provider Demographics
NPI:1053017152
Name:SCALIA, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SCALIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FAIRGREEN DR APT 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1857
Mailing Address - Country:US
Mailing Address - Phone:716-948-7823
Mailing Address - Fax:
Practice Address - Street 1:17 FAIRGREEN DR APT 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-1857
Practice Address - Country:US
Practice Address - Phone:716-948-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health