Healthcare Provider Details

I. General information

NPI: 1710004494
Provider Name (Legal Business Name): PHIL SCOZZARO PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S BROADWAY ST
AKRON OH
44308-1529
US

IV. Provider business mailing address

340 S BROADWAY ST
AKRON OH
44308-1529
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-3100
  • Fax: 330-253-5248
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5390
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: