Provider Demographics
NPI:1649990763
Name:MICHAEL SCALZO, LCSWR
Entity type:Organization
Organization Name:MICHAEL SCALZO, LCSWR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:315-601-1102
Mailing Address - Street 1:2004 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3726
Mailing Address - Country:US
Mailing Address - Phone:315-601-1102
Mailing Address - Fax:
Practice Address - Street 1:2004 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3726
Practice Address - Country:US
Practice Address - Phone:315-601-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty