Provider Demographics
NPI:1073935714
Name:BRAGG, SCOTT C (MA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:BRAGG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CREEKSIDE DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-9204
Mailing Address - Country:US
Mailing Address - Phone:610-326-2728
Mailing Address - Fax:610-326-2750
Practice Address - Street 1:600 CREEKSIDE DR
Practice Address - Street 2:SUITE 601
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9204
Practice Address - Country:US
Practice Address - Phone:610-326-2728
Practice Address - Fax:610-326-2750
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC006848OtherLICENSED PROFESSIONAL COUNSELOR