Provider Demographics
NPI:1386727709
Name:OUELLETTE, SCOTT D (MA LSWA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:MA LSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 HAILES HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777
Mailing Address - Country:US
Mailing Address - Phone:508-672-9145
Mailing Address - Fax:
Practice Address - Street 1:178 PINE STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:781-437-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40297841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312677Medicaid
MA685661OtherTUFTS
MAM18708OtherBC
MA1312677Medicaid