Provider Demographics
NPI:1083772321
Name:SCOTT, AMANDA N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:N
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 CISCO CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-6117
Mailing Address - Country:US
Mailing Address - Phone:757-773-3838
Mailing Address - Fax:
Practice Address - Street 1:7701 CISCO CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-6117
Practice Address - Country:US
Practice Address - Phone:757-773-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118541041C0700X
TX618061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61806OtherLICENSE