Provider Demographics
NPI:1558668079
Name:SCIAMMARELLA, ALEJANDRO CESAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:CESAR
Last Name:SCIAMMARELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KIM PL
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-5025
Mailing Address - Country:US
Mailing Address - Phone:631-544-0864
Mailing Address - Fax:
Practice Address - Street 1:155 3RD AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6636
Practice Address - Country:US
Practice Address - Phone:631-968-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008787-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist