Provider Demographics
NPI:1023204732
Name:SCALONE, SUSAN RENEE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:SCALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-2517
Mailing Address - Country:US
Mailing Address - Phone:443-822-8377
Mailing Address - Fax:410-741-3855
Practice Address - Street 1:10025 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2868
Practice Address - Country:US
Practice Address - Phone:443-979-8020
Practice Address - Fax:410-741-3855
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health