Provider Demographics
NPI:1912062704
Name:SCOTT, MICHAEL JOHN (PSYD, ABN)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:SCOTT
Suffix:
Gender:
Credentials:PSYD, ABN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SE 3RD TER
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4708
Mailing Address - Country:US
Mailing Address - Phone:786-202-6273
Mailing Address - Fax:
Practice Address - Street 1:414 SE 3RD TER
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4708
Practice Address - Country:US
Practice Address - Phone:786-202-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY011875-1103G00000X
13211103G00000X, 103T00000X
AZ13211103TC0700X
FLPY5960103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13211OtherPSYPACT APIT