Provider Demographics
NPI:1013383629
Name:SCOTT, CHARLES EDWARD II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:SCOTT
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:763 BEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-3306
Mailing Address - Country:US
Mailing Address - Phone:207-343-1189
Mailing Address - Fax:207-564-0060
Practice Address - Street 1:8 MOOSEHEAD LN APT 117
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1402
Practice Address - Country:US
Practice Address - Phone:207-343-1189
Practice Address - Fax:800-783-5801
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC154831041C0700X
MELC168881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400257526Medicare PIN