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NPI Code Detail

MEDICARE: DR. SCOTT GIACOMUCCI DSW, LCSW, CTTS, PAT

MEDICARE: DR. SCOTT GIACOMUCCI DSW, LCSW, CTTS, PAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCW019573PA

General Provider Information

NPI Number : 1154870889
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT GIACOMUCCI DSW, LCSW, CTTS, PAT
Provider Business Mailing Address
First Line : 524 N PROVIDENCE RD
Second Line :
City : MEDIA
State : PA
Zip : 19063-3056
Country : US
Telephone Number : 610-203-2877
Fax Number :
Provider Business Practice Location Address
First Line : 524 N PROVIDENCE RD
Second Line :
City : MEDIA
State : PA
Zip : 19063-3056
Country : US
Telephone Number : 610-203-2877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2016
Last Update Date : 11/04/2020

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