Provider Demographics
NPI:1316413859
Name:SCOTT, KRISTIE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
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 1:21 MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:CT
Mailing Address - Zip Code:06420-4057
Mailing Address - Country:US
Mailing Address - Phone:860-716-0294
Mailing Address - Fax:
Practice Address - Street 1:461 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-3103
Practice Address - Country:US
Practice Address - Phone:860-716-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical