Provider Demographics
NPI:1316328149
Name:SCOTT, ERIC B (LICENSE SOCIAL WORKE)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:B
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LICENSE SOCIAL WORKE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3710
Mailing Address - Country:US
Mailing Address - Phone:248-849-3301
Mailing Address - Fax:
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-849-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010916881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical