Provider Demographics
NPI:1366904336
Name:SCAVITTO, SELENE
Entity type:Individual
Prefix:
First Name:SELENE
Middle Name:
Last Name:SCAVITTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SELENE
Other - Middle Name:
Other - Last Name:SCAVITTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW
Mailing Address - Street 1:2322 TODD LN
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6748
Mailing Address - Country:US
Mailing Address - Phone:717-406-5190
Mailing Address - Fax:
Practice Address - Street 1:5021 E TRINDLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3528
Practice Address - Country:US
Practice Address - Phone:717-406-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1311091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW131109OtherLGSW LICENSE