Provider Demographics
NPI:1891894341
Name:SCAGLIONE, JOHANNA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:SCAGLIONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCSW, CSAC
Mailing Address - Street 1:300 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO JUNCTION
Mailing Address - State:VA
Mailing Address - Zip Code:24529-1504
Mailing Address - Country:US
Mailing Address - Phone:434-738-7562
Mailing Address - Fax:
Practice Address - Street 1:300 LAKEVIEW LN
Practice Address - Street 2:
Practice Address - City:BUFFALO JUNCTION
Practice Address - State:VA
Practice Address - Zip Code:24529-1504
Practice Address - Country:US
Practice Address - Phone:434-738-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040064141041C0700X
NY1041S0200X
NYR030398-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945514Medicaid
VA004945514Medicaid