Provider Demographics
NPI:1508066408
Name:SCIOTTO, MARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SCIOTTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 KRAUSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6572
Mailing Address - Country:US
Mailing Address - Phone:804-778-4471
Mailing Address - Fax:807-778-4463
Practice Address - Street 1:10106 KRAUSE RD STE 105
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6572
Practice Address - Country:US
Practice Address - Phone:804-778-4471
Practice Address - Fax:807-778-4463
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508066408Medicaid
VA015149C11Medicare PIN