Provider Demographics
NPI:1114210291
Name:SCOTT, KELLY ANNE
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARLOWS LANDING RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-1980
Mailing Address - Country:US
Mailing Address - Phone:508-563-5774
Mailing Address - Fax:
Practice Address - Street 1:4 BARLOWS LANDING RD
Practice Address - Street 2:SUITE 13
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1980
Practice Address - Country:US
Practice Address - Phone:508-563-5774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst