Healthcare Provider Details

I. General information

NPI: 1417774191
Provider Name (Legal Business Name): GABRIELLA SCALZO PHD, LCP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 SHRADER RD STE B
HENRICO VA
23228-2552
US

IV. Provider business mailing address

2650A JUDES FERRY RD # A
POWHATAN VA
23139-5215
US

V. Phone/Fax

Practice location:
  • Phone: 804-591-0002
  • Fax:
Mailing address:
  • Phone: 757-705-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: