Provider Demographics
NPI:1194739748
Name:SCOTT, SUSAN MATTHEWS (MFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MATTHEWS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ARCHER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2444
Mailing Address - Country:US
Mailing Address - Phone:831-423-2445
Mailing Address - Fax:
Practice Address - Street 1:303 POTRERO ST
Practice Address - Street 2:#29-107
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2741
Practice Address - Country:US
Practice Address - Phone:831-423-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC014118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA284637 / A319327 /OtherVALUE OPTIONS
CA065287OtherMANAGED HEALTH NETWORK
CA73658734OtherUSBH