Provider Demographics
NPI:1992351803
Name:TAJON-SCOTT, MARIE ROSE (MA)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ROSE
Last Name:TAJON-SCOTT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 N ST STE 5934
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5712
Mailing Address - Country:US
Mailing Address - Phone:415-636-8750
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 204-1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3932
Practice Address - Country:US
Practice Address - Phone:415-636-8750
Practice Address - Fax:650-582-0309
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140055101YM0800X, 101YM0800X
CA123741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist