Healthcare Provider Details

I. General information

NPI: 1629849724
Provider Name (Legal Business Name): KASSIDY SCALIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2343
US

IV. Provider business mailing address

45 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2343
US

V. Phone/Fax

Practice location:
  • Phone: 330-642-8242
  • Fax:
Mailing address:
  • Phone: 330-642-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.186842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: