Provider Demographics
NPI:1114026218
Name:DASH, SCOTT ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:DASH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 CANTERBURY LANE
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929
Mailing Address - Country:US
Mailing Address - Phone:610-567-5088
Mailing Address - Fax:215-318-3999
Practice Address - Street 1:650 SENTRY PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2318
Practice Address - Country:US
Practice Address - Phone:610-567-5088
Practice Address - Fax:215-318-3999
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008272L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001646Medicare ID - Type Unspecified
S44311Medicare UPIN