Provider Demographics
NPI:1023219458
Name:SCALLEY, NYDIA J (MS)
Entity Type:Individual
Prefix:MS
First Name:NYDIA
Middle Name:J
Last Name:SCALLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HUMACAO A35
Mailing Address - Street 2:VILLA AVILA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-759-9595
Mailing Address - Fax:787-767-4798
Practice Address - Street 1:A35 CALLE HUMACAO
Practice Address - Street 2:VILLA AVILA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4604
Practice Address - Country:US
Practice Address - Phone:787-759-9595
Practice Address - Fax:787-767-4798
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist