Provider Demographics
NPI:1528093200
Name:SCOTT, DAVID W (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18157
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-4157
Mailing Address - Country:US
Mailing Address - Phone:310-423-9618
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:STE 1101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4170
Practice Address - Country:US
Practice Address - Phone:310-423-9618
Practice Address - Fax:310-423-9610
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37297Medicare UPIN
CACP6343AMedicare ID - Type Unspecified