Provider Demographics
NPI:1265825079
Name:SCAVONE, CAITLIN NICOLE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NICOLE
Last Name:SCAVONE
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 1:800 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5340
Mailing Address - Country:US
Mailing Address - Phone:516-829-9666
Mailing Address - Fax:
Practice Address - Street 1:585 STEWART AVE STE 700
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4785
Practice Address - Country:US
Practice Address - Phone:516-280-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health