Provider Demographics
NPI:1619926805
Name:SCALA, MARY ELIZABETH XXXXXXXXXXXXXXXXXXX (BSN LCPC)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:XXXXXXXXXXXXXXXXXXX
Last Name:SCALA
Suffix:
Gender:F
Credentials:BSN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7267
Mailing Address - Country:US
Mailing Address - Phone:847-670-7641
Mailing Address - Fax:
Practice Address - Street 1:3250 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1563
Practice Address - Country:US
Practice Address - Phone:847-517-6365
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional