MEDICARE: LIESL ELIZABETH SCALZITTI PH.D.

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	103TC0700X	Clinical Psychologist	005272	AZ

General Provider Information

NPI Number	:	1952421695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIESL ELIZABETH SCALZITTI PH.D.

Provider Business Mailing Address
First Line	:	40001 S CHILITO LN
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-2005
Country	:	US
Telephone Number	:	520-273-0320
Fax Number	:

Provider Business Practice Location Address
First Line	:	6885 N ORACLE RD UNIT C
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4222
Country	:	US
Telephone Number	:	520-365-0058
Fax Number	:	520-369-5343

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	03/04/2024

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