MEDICARE: JOSEPH ROBERT SCOTTI PHD

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	532	WV
2	103TC0700X	Clinical Psychologist	PS004475L	PA
3	103K00000X	Behavior Analyst	532	WV
4	103K00000X	Behavior Analyst	PS004475L	PA
5	103TB0200X	Cognitive & Behavioral Psychologist	532	WV
6	103TB0200X	Cognitive & Behavioral Psychologist	PS004475L	PA
7	103TC2200X	Clinical Child & Adolescent Psychologist	532	WV
8	103TC2200X	Clinical Child & Adolescent Psychologist	PS004475L	PA
9	103TM1800X	Intellectual & Developmental Disabilities Psychologist	532	WV
10	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PS004475L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q463830281	OTHER	WV	MEDICARE PROVIDER TRANSACTION ACCESS NUMBER

General Provider Information

NPI Number	:	1992732515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ROBERT SCOTTI PHD

Provider Business Mailing Address
First Line	:	PO BOX 197
Second Line	:	WHOLE FAMILIES / WHOLE VETERANS, PLLC
City	:	MORGANTOWN
State	:	WV
Zip	:	26507-0197
Country	:	US
Telephone Number	:	304-906-9087
Fax Number	:	304-212-7379

Provider Business Practice Location Address
First Line	:	235 HIGH ST STE 716
Second Line	:	WHOLE FAMILIES / WHOLE VETERANS, PLLC
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-5448
Country	:	US
Telephone Number	:	304-906-9087
Fax Number	:	304-212-7379

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/07/2015

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