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General NPI Number Information
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NPI Number | 1609551068
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Entity Type | Individual
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Provider Name | JEFFREY THOMAS SCAVONE LPC
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Gender | Male
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 800 OLD SPRINGFIELD AVE APT 4
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City | SUMMIT
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State | NJ
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Zip | 07901-1129
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Country | US
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Telephone | 908-279-4563
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Fax |
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Provider Business Mailing Address
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Address Line | 343 CHARNWOOD RD
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-1337
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Country | US
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Telephone | 908-279-4563
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00863800
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License Number State | NJ
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