Provider Demographics
NPI:1992407548
Name:SCOTT, AMY (MS, LEP #2660)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS, LEP #2660
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 HARLAN DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5346
Mailing Address - Country:US
Mailing Address - Phone:510-612-1042
Mailing Address - Fax:
Practice Address - Street 1:1541 HARLAN DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5346
Practice Address - Country:US
Practice Address - Phone:510-612-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2660103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool