Provider Demographics
NPI:1306983457
Name:SCOTT, JENNIFER A (LICSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOBURN ST.
Mailing Address - Street 2:SUITE 26
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867
Mailing Address - Country:US
Mailing Address - Phone:774-392-1292
Mailing Address - Fax:781-287-9556
Practice Address - Street 1:22 WOBURN ST.
Practice Address - Street 2:SUITE 26
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867
Practice Address - Country:US
Practice Address - Phone:774-392-1292
Practice Address - Fax:781-287-9556
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS300180034Medicare PIN
MAS300204092Medicare PIN