Provider Demographics
NPI:1154470151
Name:GUAY, SCOTT A (LADC, NCGCII)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:GUAY
Suffix:
Gender:M
Credentials:LADC, NCGCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1251
Mailing Address - Country:US
Mailing Address - Phone:860-523-9788
Mailing Address - Fax:860-232-5049
Practice Address - Street 1:645 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2907
Practice Address - Country:US
Practice Address - Phone:860-523-9788
Practice Address - Fax:860-232-5049
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000377101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)