Provider Demographics
NPI:1386427359
Name:SCUDERO, MICHELLE ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ROSE
Last Name:SCUDERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8011
Mailing Address - Country:US
Mailing Address - Phone:732-673-0609
Mailing Address - Fax:
Practice Address - Street 1:4707 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5619
Practice Address - Country:US
Practice Address - Phone:202-244-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0237631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical