Provider Demographics
NPI:1215085774
Name:SCOTT, JUDITH CAMILLE (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:CAMILLE
Last Name:SCOTT
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 1:95 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906
Mailing Address - Country:US
Mailing Address - Phone:781-233-2693
Mailing Address - Fax:
Practice Address - Street 1:111 NORTH COMMON STREET
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4223
Practice Address - Country:US
Practice Address - Phone:781-598-5517
Practice Address - Fax:781-581-6614
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker