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General NPI Number Information
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NPI Number | 1598934507
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Entity Type | Individual
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Provider Name | SHELLY M SCAMARDO PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2008
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 330 E MAIN ST
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City | BARRINGTON
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State | IL
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Zip | 60010-3203
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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 LN
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2743
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Country | US
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Telephone | 773-495-9038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.007174
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License Number State | IL
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