MEDICARE: MRS. PANDORA ANN SCOTTO LCSW

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
1	1041C0700X	Clinical Social Worker	SW8105	FL

General Provider Information

NPI Number	:	1396933453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PANDORA ANN SCOTTO LCSW

Provider Business Mailing Address
First Line	:	8600 INDRIO RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1612
Country	:	US
Telephone Number	:	772-510-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	776 W MIDWAY RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-4203
Country	:	US
Telephone Number	:	772-519-0976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	05/23/2014

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