Provider Demographics
NPI:1972856532
Name:SCAVUZZO, JOAN MARY
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARY
Last Name:SCAVUZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARROLL
Other - Middle Name:MARY
Other - Last Name:JOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSC, MS
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3804
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3804
Practice Address - Country:US
Practice Address - Phone:609-267-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00125300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist