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General NPI Number Information
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NPI Number | 1992223341
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Entity Type | Individual
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Provider Name | LAURA ANA SCUDELLARI PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 358 VETERANS MEMORIAL HWY STE 12
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City | COMMACK
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State | NY
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Zip | 11725-4326
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Country | US
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Telephone | 631-897-6493
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SENECA ST
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1039
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Country | US
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Telephone | 631-897-6493
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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 | 022280
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License Number State | NY
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