Provider Demographics
NPI:1063838738
Name:SCALISE, ANTONIO (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:SCALISE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PINETOWN RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2605
Mailing Address - Country:US
Mailing Address - Phone:215-643-0200
Mailing Address - Fax:
Practice Address - Street 1:550 PINETOWN RD
Practice Address - Street 2:SUITE 350
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2605
Practice Address - Country:US
Practice Address - Phone:215-643-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional