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General NPI Number Information
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NPI Number | 1336811850
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Entity Type | Organization
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Legal Business Name | KIDS SPOT THERAPY
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Dates
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Enumeration Date | 10/03/2021
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Last Update Date | 10/03/2021
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Provider Practice Location Address
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Address Line | 330 E. MAIN STREET #216
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City | BARRINGTON
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State | IL
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Zip | 60010
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Country | US
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Telephone | 224-707-0156
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 KINGWOOD LANE
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City | LAKE ZURICH
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State | IL
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Zip | 60047
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Country | US
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Telephone | 224-707-0156
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELLY SCAMARDO
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Credential | PSY.D.
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Telephone | 224-707-0156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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