Provider Demographics
NPI:1306153788
Name:MARKHAM, SCOTT ALAN
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:MARKHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1810
Mailing Address - Country:US
Mailing Address - Phone:413-315-3562
Mailing Address - Fax:
Practice Address - Street 1:16 MARIA DR
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1810
Practice Address - Country:US
Practice Address - Phone:413-315-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist