Provider Demographics
NPI:1053199760
Name:SCALETTA, LEO
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:SCALETTA
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 1:23910 W INTERSTATE 10 APT 5110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1403
Mailing Address - Country:US
Mailing Address - Phone:210-584-0414
Mailing Address - Fax:
Practice Address - Street 1:23910 W INTERSTATE 10 APT 5110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1403
Practice Address - Country:US
Practice Address - Phone:210-584-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist