Provider Demographics
NPI:1811717002
Name:SCAVO, ANGELA (PSYCHOLOGIST MASTER)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SCAVO
Suffix:
Gender:F
Credentials:PSYCHOLOGIST MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MUNSON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9041
Mailing Address - Country:US
Mailing Address - Phone:802-349-0609
Mailing Address - Fax:
Practice Address - Street 1:38 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1473
Practice Address - Country:US
Practice Address - Phone:802-349-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0133713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical