Doctor Name: | CORRIN L SCAVO |
NPI Number: | 1073713236 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 071.007220 |
Business Practice Address: | 1401 Lakewood Dr Suite A Morris, IL - 604503352 |
Business Phone Number: | 8159426323 |
Business Fax Number: | 8159426423 |
Mailing Address: | 1401 Lakewood Dr, Suite A MORRIS |
State: | IL |
Postal Code: | 604503352 |
Phone Number: | 8159426323 |
Fax Number: | 8159426423 |
NPI Enumeration Date: | 07/24/2007 |
NPI Last Update Date: | 12/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.007220 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |