1689814485 NPI number — DR. STACIE D. OTEY-SCOTT PSY.D

Table of content: DR. STACIE D. OTEY-SCOTT PSY.D (NPI 1689814485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689814485 NPI number — DR. STACIE D. OTEY-SCOTT PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTEY-SCOTT
Provider First Name:
STACIE
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689814485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5326 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-533-2334
Provider Business Mailing Address Fax Number:
757-994-1511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5326 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-533-2334
Provider Business Practice Location Address Fax Number:
757-994-1511
Provider Enumeration Date:
03/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810004079 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PAR . This is a "USA MANAGED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 368853 . This is a "ANTHEM BEHAVIORAL HEALTH (GHENT FAMILY MEDICINE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "FIRST HEALTH COMMERICAL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "OPTIMA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 440878 . This is a "MANAGED HEALTH NETWORK/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VA PREMIER HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2731640 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CORVEL/CORCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1689814485 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 368851 . This is a "ANTHEM BEHAVIORAL HEALTH (PORTSMOUTH FAMILY MEDICINE)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: MIS 600566-849 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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