Provider Demographics
NPI:1104228980
Name:SCUDERI, ANTHONY J (LAADC-S)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:SCUDERI
Suffix:
Gender:M
Credentials:LAADC-S
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:SCUDERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAADC-S
Mailing Address - Street 1:9964 WINKLE CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6277
Mailing Address - Country:US
Mailing Address - Phone:916-879-9121
Mailing Address - Fax:
Practice Address - Street 1:9964 WINKLE CIRCLE
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-1904
Practice Address - Country:US
Practice Address - Phone:916-879-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACDP0320813101YM0800X
CALR15912121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health