Provider Demographics
NPI:1619656022
Name:SCIUTTO, MARK JAMES (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:SCIUTTO
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 1:747 PARK RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5611
Mailing Address - Country:US
Mailing Address - Phone:215-896-3935
Mailing Address - Fax:
Practice Address - Street 1:2005 CITY LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7701
Practice Address - Country:US
Practice Address - Phone:610-865-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009175L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist