Provider Demographics
NPI:1508580564
Name:SCAVOTTO, COURTNEY VALLADE (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VALLADE
Last Name:SCAVOTTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1532
Mailing Address - Country:US
Mailing Address - Phone:513-280-0006
Mailing Address - Fax:
Practice Address - Street 1:7602 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2106
Practice Address - Country:US
Practice Address - Phone:314-252-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110093041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical