MEDICARE: VICTOR ANTONIO SCOZZARELLA MSC, NCC, LPC

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	101YM0800X	Mental Health Counselor	LPC-15697	AZ

General Provider Information

NPI Number	:	1952756835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR ANTONIO SCOZZARELLA MSC, NCC, LPC

Provider Business Mailing Address
First Line	:	1661 N SWAN RD STE 250
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-398-4265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 N SWAN RD STE 250
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4053
Country	:	US
Telephone Number	:	520-398-4265
Fax Number	:

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	07/21/2022

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