1942681440 NPI number — THERESA SCOTT, PSY.D., LLC

Table of content: SAM PAGUNTALAN DEPASUPIL PTA (NPI 1720467020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942681440 NPI number — THERESA SCOTT, PSY.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERESA SCOTT, PSY.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1942681440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 DEVONSHIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17361-1131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-965-1952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 W PADONIA RD
Provider Second Line Business Practice Location Address:
SUITE A-203
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-965-1952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
717-965-1952

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  04444 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101518322 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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