Provider Demographics
NPI:1952421695
Name:SCALZITTI, LIESL ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:ELIZABETH
Last Name:SCALZITTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40001 S CHILITO LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-2005
Mailing Address - Country:US
Mailing Address - Phone:520-273-0320
Mailing Address - Fax:
Practice Address - Street 1:6885 N ORACLE RD UNIT C
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4222
Practice Address - Country:US
Practice Address - Phone:520-365-0058
Practice Address - Fax:520-369-5343
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005272103TC0700X, 103TC0700X
CA194471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical