Provider Demographics
NPI:1235477977
Name:SCALISE, TALIA M (MA)
Entity Type:Individual
Prefix:MISS
First Name:TALIA
Middle Name:M
Last Name:SCALISE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2800
Mailing Address - Country:US
Mailing Address - Phone:413-478-9549
Mailing Address - Fax:
Practice Address - Street 1:123 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2800
Practice Address - Country:US
Practice Address - Phone:413-478-9549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor