Healthcare Provider Details

I. General information

NPI: 1336811850
Provider Name (Legal Business Name): KIDS SPOT THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2021
Last Update Date: 10/03/2021
Certification Date: 10/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E. MAIN STREET #216
BARRINGTON IL
60010
US

IV. Provider business mailing address

1025 KINGWOOD LANE
LAKE ZURICH IL
60047
US

V. Phone/Fax

Practice location:
  • Phone: 224-707-0156
  • Fax:
Mailing address:
  • Phone: 224-707-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLY SCAMARDO
Title or Position: OWNER
Credential: PSY.D.
Phone: 224-707-0156