Provider Demographics
NPI:1417774191
Name:SCALZO, GABRIELLA (PHD, LCP)
Entity type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:
Last Name:SCALZO
Suffix:
Gender:X
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650A JUDES FERRY RD # A
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5215
Mailing Address - Country:US
Mailing Address - Phone:757-705-1099
Mailing Address - Fax:
Practice Address - Street 1:7760 SHRADER RD STE B
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2552
Practice Address - Country:US
Practice Address - Phone:804-591-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008659103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical