Healthcare Provider Details

I. General information

NPI: 1013733567
Provider Name (Legal Business Name): MONICA SCOVILLE TUDORACHE MA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 CHAMBERSBURG RD
FAYETTEVILLE PA
17222-8332
US

IV. Provider business mailing address

6490 CHAMBERSBURG RD
FAYETTEVILLE PA
17222-8332
US

V. Phone/Fax

Practice location:
  • Phone: 646-656-0992
  • Fax:
Mailing address:
  • Phone: 646-656-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: