Provider Demographics
NPI:1598191835
Name:SCOTT-FEMENELLA, THEODORE PERRYNO III (MSW, ASW, PPSC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:PERRYNO
Last Name:SCOTT-FEMENELLA
Suffix:III
Gender:M
Credentials:MSW, ASW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 AUBURN BLVD.
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841
Mailing Address - Country:US
Mailing Address - Phone:916-418-0828
Mailing Address - Fax:916-418-0838
Practice Address - Street 1:4320 AUBURN BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-418-0828
Practice Address - Fax:916-418-0838
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW28117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health