Provider Demographics
NPI:1629730668
Name:SCAMARDELLA, SANDRA (MA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SCAMARDELLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30400 TELEGRAPH RD STE 331
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4573
Mailing Address - Country:US
Mailing Address - Phone:248-629-0728
Mailing Address - Fax:
Practice Address - Street 1:30400 TELEGRAPH RD STE 331
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4573
Practice Address - Country:US
Practice Address - Phone:248-629-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical