Provider Demographics
NPI:1013733567
Name:SCOVILLE TUDORACHE, MONICA (MA)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:SCOVILLE TUDORACHE
Suffix:
Gender:U
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 CHAMBERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-8332
Mailing Address - Country:US
Mailing Address - Phone:646-656-0992
Mailing Address - Fax:
Practice Address - Street 1:6490 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-8332
Practice Address - Country:US
Practice Address - Phone:646-656-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst