=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780393876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MAYSONET CLINICAL & FORENSIC PSYCHOLOGY FIRM PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2022
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 GLENLIVET DR STE 100
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18106-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-939-2282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2796 HOMESTEAD DR
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18040-8640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-939-2822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MADELINE IVETTE MAYSONET SCAVO
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 570-939-2282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------