Provider Demographics
NPI:1629234646
Name:SCIANCALEPORE, ROSEANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:
Last Name:SCIANCALEPORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3916
Mailing Address - Country:US
Mailing Address - Phone:516-991-7471
Mailing Address - Fax:
Practice Address - Street 1:167 TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3916
Practice Address - Country:US
Practice Address - Phone:516-991-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016034103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM6851Medicare PIN