Provider Demographics
NPI:1699965269
Name:ANDERSON, SCOTT ERIC I
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ERIC
Last Name:ANDERSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 BRIDGEPORT WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6712
Mailing Address - Country:US
Mailing Address - Phone:925-957-0456
Mailing Address - Fax:
Practice Address - Street 1:2239 BRIDGEPORT WAT
Practice Address - Street 2:
Practice Address - City:MARTRINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-957-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional