Provider Demographics
NPI:1215121009
Name:NELSON, SCOTT G (LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:G
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OLD RIDGEBURY RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5128
Mailing Address - Country:US
Mailing Address - Phone:203-792-4515
Mailing Address - Fax:203-748-2632
Practice Address - Street 1:228 MEADOW ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1807
Practice Address - Country:US
Practice Address - Phone:203-597-0643
Practice Address - Fax:203-597-0834
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004123840Medicaid
CT004257516Medicaid
CT008017939Medicaid
CT008031626Medicaid