Provider Demographics
NPI:1629353354
Name:SCARDINO, PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:SCARDINO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8385 BUTTRESS LN APT 102
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-7081
Mailing Address - Country:US
Mailing Address - Phone:703-398-6592
Mailing Address - Fax:540-450-2735
Practice Address - Street 1:600 PEGASUS CT STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-5509
Practice Address - Country:US
Practice Address - Phone:540-450-2734
Practice Address - Fax:540-450-2735
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical